scholarly journals 228. Fluoroquinolone Prescribing for Diabetic Foot Infections following an FDA Drug Safety Communication for Aortic Aneurysm Risk

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S115-S116
Author(s):  
Catherine Li ◽  
Nicholas J Mercuro ◽  
Ryan Chapin ◽  
Howard Gold ◽  
Christopher McCoy
Keyword(s):  
Aortic Aneurysm ◽  
Drug Safety ◽  
Diabetic Foot ◽  
Hospitalized Patients ◽  
Transitions Of Care ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Chi Square ◽  
Safety Communication ◽  
The Impact

Abstract Background Fluoroquinolones were commonly prescribed for hospitalized patients with diabetic foot infection (DFI) at our institution, included in 69% of empiric antibiotic regimens from 2011–2014. On December 20, 2018, the U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication regarding the risk of aortic aneurysm with fluoroquinolones. The objective of this study was to assess the impact of the FDA Communication on antibiotic prescribing for DFI. Methods This was a single-center quasi-experimental study of hospitalized patients initiated on antibiotics for DFI before (February-December 2018) and after (February-December 2019) the 2018 FDA Communication. Patients with concomitant infections or documented beta-lactam or fluoroquinolone allergies were excluded. The primary outcome was inpatient days of fluoroquinolone therapy. Secondary outcomes included days of beta-lactam therapy and Outpatient Parenteral Antibiotic Therapy (OPAT) enrollment. Variables were compared using the Pearson’s chi square, Fisher’s exact, and Mann Whitney U tests, as appropriate. A logistic regression was performed to identify predictors for inpatient receipt of fluoroquinolones. Results A total of 198 patients were included. Baseline characteristics were similar between groups (Table 1). After the FDA Communication, the median duration of inpatient fluoroquinolones decreased from 3 [0–5.5] to 0 [0–1] days (p< 0.001). The duration of antipseudomonal beta-lactams increased from 0 [0–2] to 2 [0–6] days (p< 0.001). OPAT enrollment increased from 16.5% to 29.7% (p=0.028), with a corresponding increase in peripherally inserted central catheter placement (15.5% to 25.7%, p=0.074). There was no difference in outpatient fluoroquinolone prescribing over time. Incidence of re-infection, readmission for DFI, and antibiotic adverse events were similar between groups (Table 2). Table 1 Table 2 Conclusion Inpatient fluoroquinolone prescribing for DFI decreased significantly following the 2018 FDA Communication, followed by an increase in antipseudomonal beta-lactam use and OPAT enrollment. FDA statements can influence institutional antibiotic prescribing and transitions of care decisions, representing an opportunity for education by Antimicrobial Stewardship programs. Disclosures All Authors: No reported disclosures

scholarly journals Fluoroquinolone prescribing for diabetic foot infections following an FDA Drug Safety Communication for aortic aneurysm risk

2021 ◽  
Author(s):  
Catherine Li ◽  
Nicholas J. Mercuro ◽  
Ryan W. Chapin ◽  
Howard S. Gold ◽  
Christopher McCoy
Keyword(s):  
Aortic Aneurysm ◽  
Drug Safety ◽  
Diabetic Foot ◽  
The United States ◽  
Transitions Of Care ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Safety Communication ◽  
Diabetic Foot Infections ◽  
Days Of Therapy

In 2018, the United States Food and Drug Administration (FDA) issued a Drug Safety Communication regarding fluoroquinolone-associated aortic aneurysm. This quasi-experimental study assessed antibiotic prescribing for 198 hospitalized patients with diabetic foot infection. Following the warning, median inpatient fluoroquinolone days of therapy (DOT) decreased from 3 to 0 days ( P < 0.001), corresponding with increased beta-lactam DOT and OPAT enrollment. FDA communications may influence antibiotic selection and transitions of care, representing opportunities for antimicrobial stewardship.

Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics

2019 ◽  
Vol 71 (7) ◽  
pp. e88-e93 ◽  
Author(s):  
Monica L Bianchini ◽  
Rachel M Kenney ◽  
Robyn Lentz ◽  
Marcus Zervos ◽  
Manu Malhotra ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Private Insurance ◽  
Hospital Costs ◽  
Care Facility ◽  
Transitions Of Care ◽  
Beta Lactam ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Subacute Care ◽  
Cost Effective Treatment ◽  
The Impact

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a widely used, safe, and cost-effective treatment. Most public and private insurance providers require prior authorization (PA) for OPAT, yet the impact of the inpatient PA process is not known. Our aim was to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics. Methods This was an institutional review board–approved study of adult patients discharged with daptomycin, ceftaroline, ertapenem, and novel beta-lactam-beta-lactamase inhibitor combinations from January 2017 to December 2017. Patients with an OPAT PA delay were compared with patients without a delay. The primary endpoint was total direct hospital costs from the start of treatment. Results Two-hundred patients were included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a subacute care facility compared with an outpatient setting: 37 (63%) vs 52 (37%), P = .001. Discharge delays and median total direct hospital costs were higher for patients with OPAT delays: 31 (53%) vs 21 (15%), P &lt; .001 and $19 576 (interquartile range [IQR], 10 056–37 038) vs $7770 (IQR, 3031–13 974), P &lt; .001. In multiple variable regression, discharge to a subacute care facility was associated with an increased odds of discharge delay, age &gt;64 years was associated with a decreased odds of discharge delay. Conclusions OPAT with high-priced antibiotics requires significant care coordination. PA delays are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient care and address access barriers.

scholarly journals 142. Impact of an Antimicrobial Stewardship Intervention on Antibiotic Prescribing in Patients with Obstetric Infection and Penicillin Allergy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S86-S86
Author(s):  
Katelyn Quartuccio ◽  
Kelly Golden ◽  
Brenda L Tesini ◽  
Eric Heintz ◽  
Neil Seligman ◽  
...  
Keyword(s):  
Positive Impact ◽  
Group B Streptococcus ◽  
Intervention Group ◽  
Penicillin Allergy ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Post Intervention ◽  
Early Onset Sepsis ◽  
Group B ◽  
The Impact

Abstract Background Antibiotics are commonly administered in the peripartum period and most patients with penicillin allergy can tolerate beta lactams, which are preferred for the prophylaxis and treatment of several common obstetric infections. The purpose of this study was to evaluate the impact of a stewardship intervention bundle (including updates to institutional antibiotic guidelines, reclassification of severe penicillin allergy, development of order sets, and a physician champion) on the management of obstetric infections in patients with reported penicillin allergy. Methods This was a multicenter, retrospective study of adult patients presenting for labor and delivery who received at least one dose of antibiotics for an infectious indication May 1, 2018 to October 31, 2018 (pre-intervention) and May 1 2020 to October 31, 2020 (post-intervention). The primary outcome was the composite rates of patients with a reported penicillin allergy who received a preferred agent for Group B Streptococcus (GBS) prophylaxis, intraamniotic infection, or cesarean surgical site infection (SSI) prophylaxis. Results A total of 192 patients with a documented penicillin allergy were evaluated (96 patients each in pre- and post-intervention groups). Hives were the most commonly reported allergy in both groups (40% vs 39%, P=0.883). Following stewardship interventions, there was a significant increase in the rate of preferred antibiotics prescribed to patients with penicillin allergy (34.3% vs 84.3%, P&lt; 0.001), driven mainly by patients with non-severe allergy (18.4% vs 82.9%, P&lt; 0.001). There were non-statistically significant trends toward lower rates of postpartum endometritis, 30-day readmission, 90-day SSI, and neonatal early onset sepsis. Allergic reactions in the post-intervention group were limited to itching and rash in one patient each; both resolved with medical management. Conclusion A comprehensive antibiotic stewardship intervention increased preferred antibiotic prescribing for treatment and prophylaxis of obstetric infections. Pregnant patients with non-severe penicillin allergies, even those reporting hives, can tolerate beta-lactam antibiotics. The potential positive impact on clinical outcomes warrants additional investigation. Disclosures Neil Seligman, MD, Natera (Consultant)UpToDate (Other Financial or Material Support, Author)

scholarly journals The Impact of Reported Beta-Lactam Allergy in Hospitalized Patients With Hematologic Malignancies Requiring Antibiotics

2018 ◽  
Vol 67 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Kuan-Hsiang Gary Huang ◽  
Valerie Cluzet ◽  
Keith Hamilton ◽  
Olajumoke Fadugba
Keyword(s):  
Hematologic Malignancies ◽  
Hospitalized Patients ◽  
Beta Lactam ◽  
The Impact

scholarly journals Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Jenna J. Manatrey-Lancaster ◽  
Amanda M. Bushman ◽  
Meagan E. Caligiuri ◽  
Rossana Rosa
Keyword(s):  
Influenza A ◽  
Hospitalized Patients ◽  
Antibiotic Prescribing ◽  
Clinical Settings ◽  
Negative Results ◽  
Des Moines ◽  
Days Of Therapy ◽  
Tract Infections ◽  
Regression Adjustment ◽  
The Impact

Abstract Objective: The BioFire FilmArray Respiratory Panel (RFA) has been proposed as a tool that can aid in the timely diagnosis and treatment of respiratory tract infections but its effect on antibiotic prescribing among adult patients has varied. We evaluated the impact of RFA result on antibiotic days of therapy (DOTs) in 2 distinct cohorts: hospitalized patients and patients discharged from the emergency department (ED). Design: Retrospective cohort study. Setting: The study was conducted in 3 community hospitals in Des Moines, Iowa, from March 3 to March 16, 2019. Patients: Adults aged >18 years. Methods: Potential outcome means and average treatment effects for RFA results on antibiotic DOTs were estimated. Inverse probability of treatment weighting with regression adjustment was used. Results: We identified 243 patients each in the hospitalized and ED-discharged cohorts. Among hospitalized patients, RFA results did not affect antibiotic DOTs. Among patients discharged from the ED, we found that if all patients had had influenza detected, the average DOTs would have been 2.3 DOTs (−3.2 to −1.4) less than the average observed if all the patients had had a negative RFA (P < .0001); no differences in DOTs were observed when comparing an RFA with a noninfluenza virus detected compared to an RFA with negative results. Conclusions: The impact of RFA results on antibiotic DOTs varies by clinical setting, and reductions were observed only among patients discharged from the ED who had influenza A or B detected.

scholarly journals Different Patterns of Bacterial Species and Antibiotic Susceptibility in Diabetic Foot Syndrome with and without Coexistent Ischemia

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Rafał Małecki ◽  
Kamil Klimas ◽  
Aleksandra Kujawa
Keyword(s):  
Diabetic Foot ◽  
Bacterial Species ◽  
Treatment Success ◽  
Hospitalized Patients ◽  
Diabetic Foot Syndrome ◽  
Diabetic Patients ◽  
Beta Lactamase ◽  
Bacterial Strains ◽  
Culture Methods ◽  
The Impact

Aims. Infection in diabetic foot syndrome (DFS) represents serious medical problem, and the annual risk of DFS in diabetic patients is 2.5%. More than half of the patients with DFS have symptoms of extremity ischemia (peripheral arterial disease (PAD)). The aim of the present study was to analyze the frequency of particular bacterial strains in people with DFS, analyze the impact of arterial ischemia on the occurrence of a given pathogen, and evaluate the antibacterial treatment based on the results of bacterial culture. Methods. The analysis included 844 bacterial strains obtained from 291 patients with DFS hospitalized in the Department of Angiology in years 2016–2019. Results. The most common isolates were Staphylococcus aureus, Enterococcus faecalis, Enterobacter cloacae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Nearly 20% of the species were found to have at least one resistance mechanism. In patients with PAD, Gram-negative species were isolated more commonly than in people without PAD. The most useful drugs in DFS in hospitalized patients are penicillins with beta-lactamase inhibitors, 3rd- to 5th-generation cephalosporins (with many exceptions), carbapenems, aminoglycosides, and tigecycline. Conclusions. Bacterial strains isolated from ischemic DFS are more resistant to commonly used antibacterial agents, i.e., penicillins (including penicillins with beta-lactamase inhibitors), cephalosporins (except for the 4th and 5th generations), glycopeptides, and linezolid. When planning treatment of hospitalized patients with DFS, the presence of ischemia in DFS should always be taken into consideration. It determines the occurrence of particular bacterial species and the choice of antibacterial agent and may determine the rate of treatment success.

scholarly journals 131. A Pharmacist Led Antimicrobial Stewardship Pilot at Discharge Improves Outpatient Antibiotic Utilization

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S178-S178
Author(s):  
Kayla Hiryak ◽  
Geena Kludjian ◽  
Jason C Gallagher ◽  
Jason C Gallagher ◽  
Marissa Cavaretta
Keyword(s):  
Antimicrobial Stewardship ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Acceptance Rate ◽  
Transitions Of Care ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Research Support ◽  
The Impact

Abstract Background The impact of antimicrobial stewardship programs has been well observed in institutional settings; however, patients complete over one-third of their antibiotic course after discharge. This creates a gap in stewardship efforts at transitions of care. We studied whether pharmacist review of antibiotic prescriptions at discharge would improve outpatient antibiotic prescribing. Methods This was a pilot project of patients in medicine wards of an academic medical center who were discharged on oral antibiotics between February and May 2021. Patients who were pregnant, &lt;18 YO, had COVID-19, or leaving against medical advice were excluded from evaluation. For the pilot, a verification queue was created in the electronic health record (EHR) system where orders for discharge antibiotics were reviewed by investigator pharmacists before prescriptions were electronically sent to outpatient pharmacies. During the pilot, prescriptions were reviewed Monday-Friday afternoons from 12pm-4pm. Data was collected on incidence, type, and acceptance rate of pharmacist interventions, and a cost savings analysis was conducted with values calculated by the EHR system. Results There were 149 patients included with oral antibiotic prescriptions reviewed during the time frame. Of those patients, 48 (32.2%) had at least one prescription that was intervened on by a pharmacist. A total of 55 interventions were made with an acceptance rate of 76%. The median time for pharmacist review was 10 minutes (IQR 5-15). Patients who received infectious diseases (ID) consultation during admission required less intervention than patients without expert consultation but did not reach significance (8/35 and 47/114 respectively, p=0.07). The total cost savings associated with all interventions was &20,743.00. Table 1. Interventions Conclusion Direct pharmacist review and intervention at discharge improved the prescribing of oral antibiotics within our institution during this pilot. Considering that this was conducted part-time in a subset of hospitalized patients during a limited time period, significant cost savings are possible with greater implementation. Disclosures Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Consultant, Speaker’s Bureau)Merck (Consultant, Grant/Research Support, Speaker’s Bureau)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant) Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Individual(s) Involved: Self): Speakers’ bureau; Merck (Individual(s) Involved: Self): Consultant, Grant/Research Support; Nabriva: Consultant; Qpex (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant Marissa Cavaretta, PharmD, Merck (Grant/Research Support)

scholarly journals Pharmacogenetics to Avoid Loss of Hearing (PALOH) trial: a protocol for a prospective observational implementation trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044457
Author(s):  
John Henry McDermott ◽  
Rachel Mahood ◽  
Duncan Stoddard ◽  
Ajit Mahaveer ◽  
Mark A Turner ◽  
...  
Keyword(s):  
Clinical Pathways ◽  
Point Of Care ◽  
Secondary Outcome ◽  
Buccal Swab ◽  
Routine Practice ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Point Of Care Test ◽  
First Choice ◽  
The Impact

IntroductionIn conjunction with a beta-lactam, aminoglycosides are the first-choice antibiotic for empirical treatment of sepsis in the neonatal period. The m.1555A>G variant predisposes to ototoxicity after aminoglycoside administration and has a prevalence of 1 in 500. Current genetic testing can take over 24 hours, an unacceptable delay in the acute setting. This prospective-observational trial will implement a rapid point of care test (POCT), facilitating tailored antibiotic prescribing to avoid hearing loss.Methods and analysisThe genedrive POCT can detect the m.1555A>G variant in 26 min from buccal swab. This system will be integrated into the clinical pathways at two large UK neonatal centres over a minimum 6-month period. The primary outcome is the number of neonates successfully tested for the variant out of all babies prescribed antibiotics. As a secondary outcome, clinical timings will be compared with data collected prior to implementation, measuring the impact on routine practice.Ethics and disseminationApproval for the trial was granted by the Research Ethics Committee (REC) and Human Research Authority in August 2019. Results will be published in full on completion of the study.Trial registration numberISRCTN13704894.Protocol versionV 1.3.

scholarly journals Impact of a structured interview on beta-lactam reaction documentation quality

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Cynthia T. Nguyen ◽  
Randall W. Knoebel ◽  
Jennifer Pisano ◽  
Kenneth Pursell ◽  
Natasha N. Pettit
Keyword(s):  
Structured Interview ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
The Core ◽  
Documentation Quality ◽  
Core Components ◽  
The Impact

Abstract Incomplete documentation of β-lactam reactions often leads to inappropriate antibiotic prescribing. The objective of this study was to evaluate the impact of a structured interview on the quality of β-lactam reaction documentation. After 203 interviews, documentation of the core components of a β-lactam reaction improved (48% vs 1%; P < .001).

scholarly journals 230. Impact of 10-day versus 5-day Duration Default on Length of Antibiotic Outpatient Prescriptions from the Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Amber M Watts ◽  
Shannon Holt
Keyword(s):  
Emergency Department ◽  
Intervention Group ◽  
Community Acquired Pneumonia ◽  
Transitions Of Care ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
The Mean ◽  
Dental Infections ◽  
The Impact ◽  
Outpatient Prescriptions

Abstract Background Antimicrobial stewardship programs (ASP) traditionally focus on inpatient care; however there is a growing effort to optimize antibiotic prescribing at transitions of care. Longer than necessary discharge prescriptions increase risk of antimicrobial resistance, C. difficile infection and adverse events. In order to minimize unnecessary antibiotic exposure, the health system updated the electronic medical record (EMR) outpatient antibiotic prescription default from 10 days to 5 days. The objective of this study was to assess the impact of a 10-day versus 5-day EMR antibiotic outpatient prescriptions default on length of therapy for patients discharged from the Emergency Department (ED). Methods This is a retrospective, single-system cohort study evaluating ED discharge prescriptions before and after transition from a default duration of 10 days to 5 days. Discharge prescriptions were collected and screened from December 2019 through January 2020 in the control group and March 2020 through April 2020 in the intervention group. Outpatient prescriptions were included for primary diagnoses of urinary tract infection (UTI), community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), diverticulitis, or dental infections. The primary outcome was the incidence of prescriptions written for a &lt; 5 day duration. Results The study included 3060 of 9651 (32%) prescriptions in the control group and 1610 of 4938 (33%) prescriptions in the intervention group. The mean age was 38 years old with 61% female. The most common primary diagnoses were SSTI (n=1633, 35%) and UTI (n=1633, 32%). The mean duration for discharge prescriptions was similar between groups (8.44 vs. 8.30 days). The incidence of outpatient antibiotic prescriptions for &lt; 5 days was not significantly different between groups (10.72% vs 10.56%, p=0.996). There was an improvement in duration of therapy, with more prescriptions &lt; 5 days for SSTI (2.96% vs. 7.64%, p=0.860) and dental infections (3.30% vs. 10.86%, p=0.808). Conclusion Implementation of a shorter default duration for antibiotic outpatient prescriptions from the ED did not significantly increase the incidence of prescriptions written for &lt; 5 days. There was an improvement in duration for SSTI and dental infections after implementation. Disclosures All Authors: No reported disclosures

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