scholarly journals 78. Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) Nares Screen on Vancomycin Utilization for Respiratory Tract Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S156-S156
Author(s):  
Ashita Debnath ◽  
Esther King ◽  
Dimple Patel ◽  
Pamela Giordano
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Retrospective Chart Review ◽  
Audit And Feedback ◽  
Teaching Hospitals ◽  
Absolute Increase ◽  
Days Of Therapy ◽  
The Difference ◽  
Prospective Audit And Feedback ◽  
Tract Infections

Abstract Background S. aureus, including MRSA, is a common colonizer of the nares. Recent data have shown that a negative MRSA nares screen by PCR has a negative predictive value of 98%. This implies that the absence of colonization can significantly reduce empiric vancomycin utilization. This study aimed to determine the utilization of MRSA nares screening on patients receiving vancomycin for respiratory tract infections (RTI) following the addition of the screen to the institutional RTI management guidelines. Methods This was a retrospective chart review of adult inpatients presenting to two community-teaching hospitals who were prescribed vancomycin for the treatment of RTIs. Patients were divided into pre-guideline (Jan-Feb 2019), post-guideline 1 (Jan-Feb 2020), and post-guideline 2 (Jan-Feb 2021) groups. The primary endpoint was the difference in percent of vancomycin orders discontinued within 24 hours of a negative screen. Secondary endpoints included the percent of screens ordered, re-initiation of vancomycin within seven days for RTI, and total vancomycin days of therapy (DOT) per 1000 patient days (PD). Results Of 493 vancomycin orders screened, 100 orders in each arm were analyzed. There was an absolute increase of 20.6% in vancomycin orders discontinued within 24 hours of a negative screen between the pre-guideline and post-guideline 2 groups (59.1% vs. 79.7%, p = 0.0177). When compared to the pre-guideline group, utilization of the screen increased by 15% in the post-guideline 1 group (48% vs. 63%, p = 0.0328) and 26% in the post-guideline 2 group (48% vs. 74%, p = 0.000164). There was no difference in re-initiation of vancomycin. A statistically significant reduction in total vancomycin DOT/1000PD from the pre-guideline to the post-guideline 1 and 2 groups (66 to 63 to 60, respectively) was also observed. Conclusion The addition of the MRSA nares screen to the institutional RTI guidelines increased utilization of the test and demonstrated a reduction in vancomycin utilization. With an increase in education, prospective audit and feedback, and prescriber comfort with the use of the MRSA nares screen in the post-guideline 2 group, there was significant improvement in MRSA nares screen utilization, vancomycin discontinuation after a negative screen, and vancomycin utilization. Disclosures All Authors: No reported disclosures

scholarly journals 159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Anastasia Wasylyshyn ◽  
Keith S Kaye ◽  
Julia Chen ◽  
Haley Haddad ◽  
Jerod Nagel ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Upper Respiratory Tract Infections ◽  
P Value ◽  
Upper Respiratory Tract ◽  
Post Intervention ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background Asynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs). Methods In this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1). We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period. Results Among 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a). Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value < 0.001) in patients receiving guideline-concordant antibiotics. Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 days Conclusion A multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine. Disclosures Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose

scholarly journals 223. Difference in Carbapenem Use by ASP Intervention in Japanese Healthcare Facilities

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S112-S113
Author(s):  
Mio Endo ◽  
Shinya Tsuzuki ◽  
Yusuke Asai ◽  
Taichi Tajima ◽  
Nobuaki Matsunaga ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Median Number ◽  
Audit And Feedback ◽  
Average Hospital ◽  
Healthcare Facilities ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Difference ◽  
Prospective Audit And Feedback

Abstract Background Antimicrobial stewardship program (ASP) interventions have been reported to reduce unnecessary antimicrobial use (AMU). In this study, we investigated the difference in the use of carbapenems by ASP intervention in Japanese healthcare facilities. Methods Data on two components of AMU and ASP registered in Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) from January to December 2019, were used. Facilities with an infection control team in addition to an antimicrobial stewardship team responsible for the proper use of antimicrobial agents were included in the study. AMU data (such as DOT [Days of Therapy / 100 patient days]) are entered semi-automatically from medical fee statement (receipt) file at each facility. ASP intervention is divided into four categories 1) pre-authorization, 2) prospective audit and feedback (PAF), 3) PAF and required notification (RN), 4) RN. The Kruskal-Wallis test is performed to see overall difference and the Dunn test with the Bonferroni correction is done for each pair of categories. Results A total of 114 hospitals were included in the analysis. The median number of beds at participating facilities were 430 [IQR: 281–602], the median average hospital stay was 13.0 days [IQR: 11.4–15.2] and total number of inpatients per month was 10087 [6247–14536]. PAF and RN were the most common ASP interventions for carbapenems (62.5%), followed by RN (33.6%). The median DOT [IQR] of participating facilities were 2.1 [1.2–3.1] and 1) 0.7 [0.2–1.1], 2) 2.7 [2.1–3.4], 3) 2.1 [1.4–3.1] and 4) 2.0 [1.2–3.5] by ASP categories. There are significant differences between 1) and 2), 1) and 3), and 1) and 4) (p=0.014, p< 0.01 and p< 0.01, respectively) while the differences between 2) and 3), 2) and 4), and 3) and 4) are not significant (p=1.00). Table 1. Summary statistics of healthcare facilities by ASP Interventions Figure 1. DOT by ASP Interventions Conclusion Only 3.5% of ASP interventions belong to 1) pre-authorization category and this might be due to the complexity of registration process. This category was found to have the lowest DOT among all ASP interventions in Japanese healthcare facilities. The variances of DOT were especially large in categories 3) and 4), and more detailed analyses would be necessary to evaluate their efficacies accurately. Disclosures All Authors: No reported disclosures

scholarly journals Factors Associated with Antibiotic Misuse in Outpatient Treatment for Upper Respiratory Tract Infections

2015 ◽  
Vol 59 (7) ◽  
pp. 3848-3852 ◽  
Author(s):  
Jennifer L. Schroeck ◽  
Christine A. Ruh ◽  
John A. Sellick ◽  
Michael C. Ott ◽  
Arun Mattappallil ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Respiratory Tract Infections ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

ABSTRACTThe Centers for Disease Control and Prevention has promoted the appropriate use of antibiotics since 1995 when it initiated the National Campaign for Appropriate Antibiotic Use in the Community. This study examined upper respiratory tract infections included in the campaign to determine the degree to which antibiotics were appropriately prescribed and subsequent admission rates in a veteran population. This study was a retrospective chart review conducted among outpatients with a diagnosis of a respiratory tract infection, including bronchitis, pharyngitis, sinusitis, or nonspecific upper respiratory tract infection, between January 2009 and December 2011. The study found that 595 (35.8%) patients were treated appropriately, and 1,067 (64.2%) patients received therapy considered inappropriate based on the Get Smart Campaign criteria. Overall the subsequent readmission rate was 1.5%. The majority (77.5%) of patients were prescribed an antibiotic. The most common antibiotics prescribed were azithromycin (39.0%), amoxicillin-clavulanate (13.2%), and moxifloxacin (7.5%). A multivariate regression analysis demonstrated significant predictors of appropriate treatment, including the presence of tonsillar exudates (odds ratio [OR], 0.6; confidence interval [CI], 0.3 to 0.9), fever (OR, 0.6; CI, 0.4 to 0.9), and lymphadenopathy (OR, 0.4; CI, 0.3 to 0.6), while penicillin allergy (OR, 2.9; CI, 1.7 to 4.7) and cough (OR, 1.6; CI, 1.1 to 2.2) were significant predictors for inappropriate treatment. Poor compliance with the Get Smart Campaign was found in outpatients for respiratory infections. Results from this study demonstrate the overprescribing of antibiotics, while providing a focused view of improper prescribing. This article provides evidence that current efforts are insufficient for curtailing inappropriate antibiotic use.

scholarly journals Impact of Nasal Swabs on Empiric Treatment of Respiratory Tract Infections (INSERT-RTI)

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 101
Author(s):  
Vanessa Huffman ◽  
Diana Carolina Andrade ◽  
Jared Ham ◽  
Kyle Brown ◽  
Leonid Melnitsky ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Hospital Length ◽  
Primary Objective ◽  
Hospital Length Of Stay ◽  
Significant Difference ◽  
Nasal Swabs ◽  
Before And After ◽  
The Difference ◽  
Tract Infections

Methicillin-resistant Staphylococcus aureus (MRSA) polymerase-chain-reaction nasal swabs (PCRNS) are a rapid diagnostic tool with a high negative predictive value. A PCRNS plus education “bundle” was implemented to inform clinicians on the utility of PCRNS for anti-MRSA therapy de-escalation in respiratory tract infections (RTI). The study included patients started on vancomycin with a PCRNS order three months before and after bundle implementation. The primary objective was the difference in duration of anti-MRSA therapy (DOT) for RTI. Secondary objectives included hospital length of stay (LOS), anti-MRSA therapy reinitiation, 30-day readmission, in-hospital mortality, and cost. We analyzed 62 of 110 patients screened, 20 in the preintervention and 42 in the postintervention arms. Mean DOT decreased after bundle implementation by 30.3 h (p = 0.039); mean DOT for patients with a negative PCRNS decreased by 39.7 h (p = 0.014). Median cost was lower after intervention [USD$51.69 versus USD$75.30 (p < 0.01)]. No significant difference in LOS, mortality, or readmission existed. The bundle implementation decreased vancomycin therapy and cost without negatively impacting patient outcomes.

scholarly journals 240. Reduction of antibiotic use in children admitted with viral respiratory tract infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
Ankhi Dutta ◽  
Huay-Ying Lo ◽  
Amrita Singh ◽  
Samrah Mobeen ◽  
Kelli Kulik ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Process Measures ◽  
Days Of Therapy ◽  
Tract Infections ◽  
Viral Respiratory

Abstract Background Viral respiratory tract infections (VRTI) accounts for a significant proportion of hospitalized children and contributes to a substantial use of health care resources and costs. American Academy of Pediatrics (AAP) recommends against using antibiotics in uncomplicated viral respiratory infections in children. Overuse of antibiotics ranges between 29–80%. The goal of an Antibiotic stewardship programs (ASP) is to decrease antibiotic misuse, lower costs, and prevent emergence of antibiotic resistance in the community. Proportion of children with Viral respiratory tract infections on antibiotics Methods Our smart aim was to reduce antibiotic use by 25% in admitted children with VRTI between October 2019-March 2020. Our outcome measure was to reduce inappropriate antibiotic use during the 2019–20 season by 25%. Process measures included percentage of antibiotic used in viral RTI, antibiotic days of therapy and appropriate audit-feedback from the ASP team to facilitate discontinuation or de-escalation of antibiotics based on culture data. Our balance measure included readmission rates in patients in whom antibiotics were discontinued or de-escalated. Several PDSA cycles implemented with predominant emphasis on communication between ASP team and primary providers. Results No differences were noted in patient demographics including sex, age, ethnicity between the viral season in 2018–19 and 2019–2020. In our previous study in 2018–2019 RSV season, there was 40.7% antibiotic use in patients admitted with RSV bronchiolitis. In 2019–2020 season we included all patients admitted with viral RTI. Of the 213 patients evaluated between October 2019 through Dec 2020, 40% of the patients received antibiotics. 100% of the antibiotics were justified, based on independent review of antibiotic data by the team. Most common cause of antibiotics were community acquired pneumonia, rule out sepsis and otitis media. Antibiotic discontinuation and de-escalation were achieved in over 90% of the justified antibiotics. Conclusion Though antibiotic usage was still at 40% at our institution, 100% of antibiotic use was deemed appropriate and significant proportion were discontinued or deescalated by the ASP team. The ASP team played a crucial role in communicating with the primary providers to advocate for appropriate antibiotic use in the children. Disclosures All Authors: No reported disclosures

scholarly journals 99. Comparison of Procalcitonin Testing to a Targeted Audit-and Feedback Strategy on Prescribed Durations of Therapy for Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S64-S64
Author(s):  
Lauren Clark ◽  
Lisa E Dumkow ◽  
Paige Buss ◽  
Thomas Beuschel ◽  
Andrew Jameson
Keyword(s):  
Average Duration ◽  
Community Acquired Pneumonia ◽  
Audit And Feedback ◽  
Teaching Hospitals ◽  
Post Intervention ◽  
Comfort Care ◽  
Duration Of Therapy ◽  
Days Of Therapy ◽  
Tract Infections ◽  
The Impact

Abstract Background The procalcitonin (PCT) assay is FDA-approved to help guide antimicrobial treatment of respiratory tract infections, however, conflicting data exist regarding its impact on shortening durations of therapy. The purpose of this study was to compare the impact of PCT to a targeted audit-and-feedback (TAF) strategy on prescribed antibiotic durations of therapy for community-acquired pneumonia (CAP). Methods A retrospective cohort study was conducted at two community teaching hospitals, one implementing PCT with routine audit-and-feedback and one implementing a TAF strategy recommending 5 days of therapy for uncomplicated CAP. The primary objective of this study was to compare the impact of PCT implementation to TAF implementation on durations of therapy prescribed for suspected CAP. Secondary objectives included comparing length of stay, 30-day readmission, mortality, and rates of Clostridioides difficile. Adult inpatients with an antibiotic ordered with an indication of pneumonia were eligible for inclusion. Those who were critically ill, immunocompromised, had concurrent infections, were made comfort care, discharged or expired within 48 hours were excluded. Results 311 patients were included (Pre-TAF n=80, Pre-PCT n=80, Post-TAF n=80, Post-PCT n=71). Average duration of therapy prescribed for CAP at baseline was similar between groups, Pre-TAF 7.0 days vs. Pre-PCT 7.8 days (p=0.1). After implementation of the respective interventions, there remained no difference in the average duration of therapy between groups, Post-TAF 5.5 days vs. Post-PCT 5.4 days (p=0.8). Both PCT and TAF strategies demonstrated significant improvement in prescribed durations for CAP between their respective Pre- and Post-intervention groups (p&lt; 0.001 and p=0.002, respectively). The PCT protocol was followed 41% of the time in the Post-PCT group. There were no differences in readmission, mortality, or C. difficile between groups. Conclusion PCT and TAF were equally effective antimicrobial stewardship strategies in reducing total days of antibiotic therapy prescribed for CAP with no differences observed in patient outcomes. Disclosures All Authors: No reported disclosures

Adenovirus respiratory tract infections in infants: a retrospective chart-review study

The Lancet ◽  
2018 ◽  
Vol 391 ◽  
pp. S43 ◽  
Author(s):  
Shaden Jobran ◽  
Randa Kattan ◽  
Jamal Shamaa ◽  
Hiyam Marzouqa ◽  
Musa Hindiyeh
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Review Study ◽  
Tract Infections

scholarly journals Hospital-acquired Respiratory-Tract Infections in the Teaching Hospitals of Sfax

2021 ◽  
Author(s):  
Maissa Ben Jmaa ◽  
Sourour Yaich ◽  
Houda Ben Ayed ◽  
Maroua Trigui ◽  
Mariem Ben Hmida ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Teaching Hospitals ◽  
Tract Infections ◽  
Hospital Acquired

Outcomes of Cefazolin versus Ceftriaxone Therapy in Treating Lower Respiratory Tract Infections in Adults

1992 ◽  
Vol 26 (12) ◽  
pp. 1503-1507 ◽  
Author(s):  
David Thompson ◽  
Daniel M. Huse ◽  
Gerry Oster
Keyword(s):  
Respiratory Tract ◽  
Hospital Discharge ◽  
Antimicrobial Therapy ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Lower Respiratory Tract Infections ◽  
Parenteral Antibiotic ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
Tract Infections

OBJECTIVE: To determine whether choice of a first- versus third-generation cephalosporin as initial therapy for lower respiratory tract infections in hospitalized adults affects the course and duration of care, both of which may influence antimicrobial treatment cost. DESIGN: Retrospective analysis of discharge abstracts and hospital pharmacy records. SETTING: Forty-eight US acute-care hospitals. PATIENTS: One thousand ninety-two hospitalized adults (aged >17 y) with principal diagnoses of lower respiratory tract infections (DRGs 79–80, 89–90). INTERVENTIONS: Cefazolin or ceftriaxone, given as sole antimicrobial therapy for at least one day. MAIN OUTCOME MEASURES: (1) The number of patients who received another parenteral antibiotic anytime prior to hospital discharge; (2) the number of days during which patients received any parenteral antibiotic while in the hospital; and (3) the number of days patients remained hospitalized following the start of antibiotic therapy. RESULTS: Patients treated with cefazolin (n=763) were more likely to receive another parenteral antibiotic while in the hospital (30.3 vs. 20.7 percent; p<0.001) and received more total days of therapy (7.2 vs. 6.7 d; p<0.05) than those treated with ceftriaxone (n=329). Although the time to hospital discharge did not differ in the full sample (9.2 d for both groups), it was greater among those receiving cefazolin (8.6 vs. 8.0 d; p<0.05) when patients with lengths of stay exceeding 24 days were excluded from both groups. CONCLUSIONS: In addition to acquisition cost, differences in course and duration of care should be considered when determining the most cost-effective choice for antimicrobial therapy.

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