scholarly journals 219. Characteristics Associated with Inappropriate Antibiotic Prescribing in Patients with Asymptomatic Bacteriuria (ASB)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S111-S111
Author(s):  
Morgan L Bixby ◽  
Brian R Raux ◽  
Aakansha Bhalla ◽  
Christopher McCoy ◽  
Elizabeth B Hirsch
Keyword(s):  
Antibiotic Treatment ◽  
Inappropriate Prescribing ◽  
White Blood Cells ◽  
Asymptomatic Bacteriuria ◽  
Panel Member ◽  
Culture Collection ◽  
Antibiotic Prescribing ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Klebsiella Spp

Abstract Background Antibiotic treatment of asymptomatic bacteriuria (ASB) is considered inappropriate, does not improve patient outcomes, and may lead to adverse events such as antibiotic resistance and Clostridioides difficile infection. Previous stewardship interventions have focused on reducing unnecessary urine culture collection in individuals without urinary symptoms; however, further interventions to reduce inappropriate prescribing in ASB are warranted. This study sought to identify characteristics associated with treatment of ASB in order to implement future stewardship interventions. Methods This two-center, retrospective cohort study included unique emergency department or inpatient adults with consecutive non-duplicate monomicrobial urine isolates of Enterobacterales or Pseudomonas aeruginosa collected between 8/2013 and 1/2014 from two academic hospitals in Boston, Massachusetts. Patients with ASB (without chart-documented urinary-specific symptoms) were identified through chart review and stratified into two groups: those treated with empiric urinary tract infection (UTI) antibiotics and those untreated. Logistic regression analyses were performed to identify variables independently associated with antibiotic treatment of ASB. Results During the study, 255 patients were determined to have ASB and a majority (80.8%) were treated with empiric UTI antibiotics. Most patients were female (71.4%) and elderly (mean age 70 years). The most common organisms isolated were Escherichia coli (59.2%), Klebsiella spp. (23.1%), and P. aeruginosa (9.8%). The presence of isolated fever (OR, 7.83 [95% confidence interval, 1.51, 144.20]); p = 0.05), urinalysis positive for pyuria (>10 white blood cells) (OR, 2.52 [95% CI, 1.15, 5.54]; p = 0.02), and Klebsiella spp. urine isolate (OR, 2.99 [95% CI, 1.19, 8.60]; p = 0.02) were independently associated with treatment. Conclusion A large proportion of ASB patients were treated with antibiotics despite clinical practice guidelines recommending against this practice. Isolated fever, pyuria, and Klebsiella spp. culture were all significantly associated with the treatment of ASB; targeted review of these patients by stewardship programs may help to reduce inappropriate ASB treatment within these institutions. Disclosures Elizabeth B. Hirsch, PharmD, Merck (Grant/Research Support) Nabriva Therapeutics (Advisor or Review Panel member)

scholarly journals Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Lindsay A Petty ◽  
Valerie M Vaughn ◽  
Scott A Flanders ◽  
Twisha Patel ◽  
Anurag N Malani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antibiotic Treatment ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Altered Mental Status ◽  
Estimating Equation ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Cord Injury ◽  
Clostridioides Difficile Infection

Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. Methods We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018–February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Results Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08–1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P = .02). Conclusions Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.

scholarly journals Are Urinalyses Used Inappropriately in the Diagnosis of Urinary Tract Infections?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S350-S350 ◽  
Author(s):  
Ghada Elshimy ◽  
Vincent Mariano ◽  
Christina Mariyam Joy ◽  
Parminder Kaur ◽  
Monisha Singhal
Keyword(s):  
Urinary Tract ◽  
Antibiotic Treatment ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
White Blood Cells ◽  
Asymptomatic Bacteriuria ◽  
Further Education ◽  
Positive Urine ◽  
Tract Infections ◽  
Hospital Wards

Abstract Background One of the most readily available and cost effective tests in the diagnosis of urinary tract infections (UTI) is the urinalysis. Problems arise when antibiotic treatment is initiated in a patient who does not display typical signs and symptoms of UTI and for whom a urinalysis was obtained for other reasons. Methods This was a retrospective observational study carried out on 1000 patients with positive urine nitrite. Medical records were identified with subsequent analysis of urine culture and symptomatology. Recorded and analyzed data included: age, sex, location (emergency room (ER) or hospital ward), findings on urinalysis (pH, presence of leukocyte esterase(LE), epithelial cells, bacteria, and white blood cells (WBCs)) and antibiotic treatment. Results Of these 1000 patients with positive nitrite, we excluded 815 patients (81 had missing data, 466 met exclusion criteria and 268 had symptomatic UTI). 185 were found to not have any symptoms of a UTI. Inappropriate antibiotic treatment occurred in 108/185 patients (58.4%) and was significantly associated with greater amounts of bacteria and WBCs in the urinalyses (P = 0.008 and P = 0.029, respectively). It was also significantly more likely to occur in the ER than the hospital wards (92/147 treated in the ER vs. 16/37 treated on the hospital wards, P = 0.033). There was no significant association between antibiotic treatment and age, sex, urine pH, urine LE, and urine epithelial cell amounts (P > 0.05). Urine cultures were not obtained in 69.7% of patients. A positive urine culture was significantly associated with inappropriate antibiotic treatment (P = 0.0006). The two most common presenting complaints were psychiatric complaints (21.6%) and vaginal bleeding (14.6%). Conclusion Urinalysis can be an invaluable diagnostic tool, but must be used and interpreted appropriately. There is a misperception that pyuria with bacteriuria defines UTI. However, positive results on a urinalysis alone in an asymptomatic patient is not enough to diagnose a UTI, and antibiotic treatment is only indicated in specific circumstances as outlined by IDSA guidelines for the treatment of asymptomatic bacteriuria. Further education targeting appropriate interpretation of urinalyses and IDSA guidelines is needed to decrease the unnecessary use of antibiotics. Disclosures All authors: No reported disclosures.

scholarly journals Treatment for Positive Urine Cultures in Hospitalized Adults: A Survey of Prevalence and Risk Factors in 3 Medical Centers

2015 ◽  
Vol 37 (3) ◽  
pp. 319-326 ◽  
Author(s):  
Jonathan D. Grein ◽  
Katherine L. Kahn ◽  
Samantha J. Eells ◽  
Seong K. Choi ◽  
Marianne Go-Wheeler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Treatment ◽  
Broad Spectrum ◽  
White Blood Cells ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Diagnostic Concordance

BACKGROUNDAntibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines.OBJECTIVETo evaluate risk factors for treatment of ASB.DESIGNRetrospective observational study.SETTINGA tertiary academic hospital, county hospital, and community hospital.PATIENTSHospitalized adults with bacteriuria.METHODSPatients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.RESULTSAmong 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14–0.80], P =.01), presence of leukocyte esterase (5.48 [2.35–12.79], P<.01), presence of nitrites (2.45 [1.11–5.41], P=.03), and Escherichia coli on culture (2.4 [1.2–4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%.CONCLUSIONSASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.Infect. Control Hosp. Epidemiol. 2016;37(3):319–326

scholarly journals Microbiota-based markers predictive of development of Clostridioides difficile infection

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Matilda Berkell ◽  
◽  
Mohamed Mysara ◽  
Basil Britto Xavier ◽  
Cornelis H. van Werkhoven ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Intestinal Microbiota ◽  
Healthcare Costs ◽  
Beta Lactams ◽  
Clostridioides Difficile ◽  
Before And After ◽  
Clostridioides Difficile Infection ◽  
Patients At Risk ◽  
Risk Patients ◽  
Considerable Morbidity

AbstractAntibiotic-induced modulation of the intestinal microbiota can lead to Clostridioides difficile infection (CDI), which is associated with considerable morbidity, mortality, and healthcare-costs globally. Therefore, identification of markers predictive of CDI could substantially contribute to guiding therapy and decreasing the infection burden. Here, we analyze the intestinal microbiota of hospitalized patients at increased CDI risk in a prospective, 90-day cohort-study before and after antibiotic treatment and at diarrhea onset. We show that patients developing CDI already exhibit significantly lower diversity before antibiotic treatment and a distinct microbiota enriched in Enterococcus and depleted of Ruminococcus, Blautia, Prevotella and Bifidobacterium compared to non-CDI patients. We find that antibiotic treatment-induced dysbiosis is class-specific with beta-lactams further increasing enterococcal abundance. Our findings, validated in an independent prospective patient cohort developing CDI, can be exploited to enrich for high-risk patients in prospective clinical trials, and to develop predictive microbiota-based diagnostics for management of patients at risk for CDI.

scholarly journals 801. Patients with Clostridioides difficile Infection Following Dental Antibiotic Prescription

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S444-S444
Author(s):  
Geneva M Wilson ◽  
Charlesnika T Evans ◽  
Margaret A Fitzpatrick ◽  
Linda Poggensee ◽  
Kelly Echevarria ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Oral Infection ◽  
Descriptive Statistics ◽  
Antibiotic Prescribing ◽  
Dental Visit ◽  
Dental Visits ◽  
Clostridioides Difficile ◽  
Post Procedure ◽  
Cardiac Condition ◽  
Clostridioides Difficile Infection

Abstract Background Dentists prescribe few broad-spectrum antibiotics but are the primary prescriber of clindamycin in the U.S. Data is scarce on the association of dental antibiotic prescribing and Clostridioides difficile infection (CDI). Here we present results from a longitudinal cohort of patients with a CDI positive diagnostic test 30 days after receiving an antibiotic prescribed by a dentist. Methods A cohort of patients with antibiotic prescriptions within 7 days of a dental visit were identified from 2015-2018. From this cohort, patients with positive C. difficile test 30 days after a dental antibiotic were included. Chart reviews obtained information about the dental visit, antibiotic prescribed, and CDI diagnosis. Descriptive statistics were used to describe characteristics of those with CDI following a dental antibiotic. Results 212,763 Veterans received an antibiotic from a dentist between 2015-2018. Of them, 87 patients had a positive CDI test within 30 days of receiving their dental antibiotic. Over half (57.4%) of these patients had surgical dental visits and 45.9% had an oral infection coded. Dentists documented reasons for prescription was treatment of a local infection (40%) and post procedure prophylaxis (24%). Amoxicillin (54.0%) and clindamycin (40.2%) were the most commonly prescribed antibiotics. 65.7% of the patients that received clindamycin from the dentist had a documented penicillin allergy. 58.6% of patients had a preexisting gastrointestinal condition and 44.8% were taking gastric acid reducer medication. Only 19.5% of the antibiotic prescriptions met ADA guidelines for appropriate antibiotics (presence of gingival manipulation and a cardiac condition). CDI cases were treated with metronidazole (55.2%), or vancomycin (37.9%); 5.7% had no apparent treatment through the VA. The average number of days between the dental visit and CDI diagnosis was 18.9. Conclusion The occurrence of CDI was infrequent after a dental antibiotic. However, clindamycin was prescribed more frequently in this cohort than published literature on dentist prescribing. Approximately half had a gastrointestinal risk factor for CDI. More research is needed to determine the type of patient most at risk for CDI following a dental antibiotic. Disclosures All Authors: No reported disclosures

scholarly journals 766. Readmissions of Hospitalized Patients with Clostridioides difficile Infection (CDI) for Recurrent CDI Is Common

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
Emily N Drwiega ◽  
Larry H Danziger ◽  
Stuart Johnson ◽  
Andrew M Skinner
Keyword(s):  
Medical Center ◽  
Hospital Readmissions ◽  
Panel Member ◽  
Hospitalized Patients ◽  
Recurrent Episode ◽  
Review Panel ◽  
Infectious Disease Physician ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Hospital acquired infections (HAI) and hospital readmissions are of particular focus by Centers for Medicare and Medicaid Services. Clostridioides difficile infection (CDI) is an HAI notorious for causing recurrent illness and potentially resulting in re-hospitalizations. The purpose of our study was to identify the frequency of follow-up appointments in patients with CDI and determine the rate of re-hospitalization for recurrent CDI (rCDI). Methods This was a single-center, retrospective, chart review at a tertiary medical center. Through the electronic medical record, we queried all hospitalized patients with a positive stool test for C. difficile (GI panel PCR, FilmArray, Biofire, or C. difficile PCR, Xpert CD assay, Cepheid) with or without an ICD-10 code Enterocolitis due to C. difficile (A04.7, A04.71, A04.72) from January 2018 through April 2018. Demographic and clinical data at the time of diagnosis and up to 90 days after were collected from patient records. Results One-hundred and eighty-five patient episodes were evaluated. Of these, 147 (79.5%) were primary CDI, 13 (7.0%) were rCDI, and 25 (13.5%) were determined to be colonization. Twenty-two (11.9%) patients from the total cohort attended a follow-up appointment for CDI within 30 days, most often with a primary care provider or infectious disease physician. Twenty-three (12.4%) patients, 18 of whom were hospitalized for primary CDI episodes, developed a recurrent episode within 90 days of their initial CDI episode. Of these 23 patients with rCDI, 10 (43.5%) patients were re-hospitalized for their rCDI. Only 4 (17.4%) patients with rCDI had a follow-up appointment after their primary episode and among the 10 patients re-hospitalized for rCDI, only 2 (20.0%) patient had been seen for follow up for their previous CDI episode. Conclusion In our study, few patients had a follow-up appointment for CDI. Also, more than one third of the patients who had rCDI had to be re-hospitalized for the recurrent episode. Our study highlights a concern that the majority of patients re-hospitalized with rCDI did not have a follow-up appointment within 30 days of their initial diagnosis. Further study is necessary to determine if a dedicated follow-up appointment for CDI would result in decreased re-hospitalizations associated with rCDI. Disclosures Stuart Johnson, MD, Acurx Pharmaceuticals (Advisor or Review Panel member)Bio-K+ (Advisor or Review Panel member)Ferring Pharmaceutical (Advisor or Review Panel member)

scholarly journals 218. Evaluation of Clinical Outcomes with Shorter Vs. Longer Duration of Treatment for Common Inpatient Bacterial Infections Associated with Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S128-S128
Author(s):  
Leila Hojat ◽  
Mary T Bessesen ◽  
Margaret Reid ◽  
Bryan C Knepper ◽  
Matthew A Miller ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Primary Outcome ◽  
Safety Net ◽  
Duration Of Treatment ◽  
Duration Of Therapy ◽  
Clostridioides Difficile ◽  
Short Course ◽  
Tertiary Center ◽  
Clostridioides Difficile Infection

Abstract Background Pneumonia (PNA), urinary tract infection (UTI), and acute bacterial skin and skin structure infection (ABSSSI) are the most common infections treated in the inpatient setting and often are associated with bacteremia. Though short courses of treatment are advocated for these infections in general, no established guidelines exist for cases involving bacteremia. We evaluated the clinical outcomes of patients receiving short (5–9 days) vs. long (10–15 days) duration of antibiotic treatment. Methods A retrospective study was conducted at 3 area hospitals comprising a university-based tertiary center, a public safety net hospital, and a Veterans’ Affairs hospital. We included hospitalized adult patients with transient bacteremia associated with uncomplicated cases of PNA, UTI, or ABSSSI. The primary outcome consisted of a composite of rehospitalization or resumption of antibiotic treatment attributed to the original infection or death due to any cause within 30 days of the antibiotic start date. Secondary outcomes included the individual composite components, Clostridioides difficile infection, and antibiotic-related adverse effects leading to change in antibiotic therapy. A propensity score weighted logistic regression model was used to mitigate factors which could bias a patient toward receiving a shorter or longer treatment duration. Results Of 411 patients included in the study, 123 (29.9%) received a short duration of therapy and 288 (70.1%) received a long duration of therapy. The median duration of treatment was 8 days in the short group and 13 days in the long group. In the propensity-weighted analysis, the probability of meeting the composite primary outcome was not statistically different between the short and long groups (Table 1). However, receiving a short course was associated with a higher probability of restarting antibiotics and Clostridioides difficile infection. Conclusion Shorter vs. longer courses of antibiotic treatment for bacteremia associated with PNA, UTI, and ABSSSI were not significantly different in a composite of readmission, restart of antibiotics, and mortality; however, further study is needed to evaluate the safety and effectiveness of short-course therapy. Disclosures All authors: No reported disclosures.

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