scholarly journals 102. Evaluation of the Association between the Antibiotic Spectrum Index and Antibiotic Days of Therapy: A Retrospective Study across 124 Acute-care Hospitals

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S165-S166
Author(s):  
Satoshi Kakiuchi ◽  
Michihiko Goto ◽  
Fernando Casado-Castillo ◽  
Eli N Perencevich ◽  
Daniel J Livorsi
Keyword(s):  
Acute Care ◽  
Rank Order ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Hospital Performance ◽  
Veterans Health ◽  
Health Administration ◽  
Hospital Level ◽  
Average Spectrum ◽  
Days Of Therapy

Abstract Background Antibiotic stewardship programs often measure antibiotic days of therapy (DOT), but this metric does not reflect the antibiotic spectrum. In this study, we used the previously published Antibiotic Spectrum Index (ASI), which attaches a score (1-13) to the spectrum of each antibiotic, to evaluate the content of antibiotic use across all Veterans Health Administration (VHA) hospitals. We also assessed how benchmarking hospital performance changed when ASI was used instead of DOT. Methods We conducted a retrospective cohort study of patients admitted to 124 acute-care VHA hospitals during 2018. We obtained data on administered antibiotics, the days of antibiotic use (DOT), and days-present (DP) from the VHA Corporate Data Warehouse and then aggregated data to the hospital-level using the National Healthcare Safety Network’s methodology. We modified the original ASI by changing 3.8% of the bug-drug scores to ensure consistency across all scores and adding 27 new antibiotics agents. For each hospital, we calculated ASI/DOT, ASI/1,000 DP, and DOT/1,000 DP and ranked hospitals on their performance. We performed a Spearman’s rank-order correlation to compare hospitals on these metrics and their associated rankings. Results At the hospital-level, the median ASI/DOT, ASI/1,000 DP and DOT/1,000 DP were 5.4 (interquartile range: 5.2-5.8), 2,332.7 (1,941.8-2,796.2) and 443.5 (362.5-512.2), respectively. There was a strong correlation between the ASI/1,000 DP and DOT/1,000 DP metrics [Spearman’s correlation test: r=0.97 (p< 0.01)] but only a weak and insignificant correlation between ASI/DOT and DOT/1,000 DP [r=0.17 (p=0.06), Figure 1]. Twenty (16.1%) hospitals showed a difference of 10% or more in their ranking for ASI/1,000 DP compared to their ranking for DOT/1,000 DP. The range of ranking difference was from -17.7% to 21.0% (Figure 2a and b). Figure 1. Distribution of the Antibiotic Spectrum Index / Day of Therapy by Days of Therapy / 1000 Days Present for 124 Acute-Care VHA Hospitals during 2018. Black line: Median values of DOT/1,000 DP and ASI/DOT, respectively. Figure 2. (a) Distribution of the rankings in DOT/1,000 DP and ASI/1,000 DP. Blue line: the position of same ranking between ASI/1,000 DP and DOT/1,000 DP. (b) Distribution of the differences in each hospital’s ranking for DOT/1,000 DP and ASI/1,000 DP Conclusion Our findings suggest that hospitals using fewer days of antibiotic therapy did not necessarily use narrower-spectrum antibiotics. ASI/1,000 DP, as a combined measure of antibiotic consumption quantity and average spectrum, provided a different view of hospital performance than DOT/1,000 DP alone. Future work is needed to define how this new metric relates to the quality of antibiotic use. Disclosures All Authors: No reported disclosures

scholarly journals 21. Association of MRSA Prevalence and Hospital-level Antibiotic Use: A Retrospective Study Across 122 Acute-care Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S11-S11
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Brian Lund ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Case Mix ◽  
Veterans Health ◽  
Health Administration ◽  
Hospital Level ◽  
Days Of Therapy ◽  
Research Grant

Abstract Background The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), varies across geographic regions, which could contribute to regional variation in antibiotic use. In this study, we evaluated whether local MRSA prevalence rates were associated with hospital-level antibiotic use across the Veterans Health Administration (VHA). Methods This retrospective cohort included all acute-care patients admitted in VHA hospitals during 2016. Anti-MRSA antibiotics were identified per National Healthcare Safety Network definitions and use was quantified as days-of-therapy (DOT) per 1000 days-present. Hospital-level MRSA prevalence (colonization and/or infection) was determined by calculating the proportion of admissions with a positive MRSA nasal swab and/or a MRSA-positive clinical culture obtained ≤1 day before or ≤2 days after admission. Negative binomial regression models were used to determine the association between a hospital’s MRSA prevalence and its antibiotic use, after accounting for intra-hospital clustering, patient case-mix, month of admission, and use of hospital-based stewardship strategies. Results There were 548,476 admissions across 122 hospitals. The median rate of MRSA prevalence at admission was 8.0% (IQR 6.7–9.7%). Hospital level median use of anti-MRSA and total antibiotics was 96.5 (interquartile range [IQR] 81.1–116.9) and 562.1 (IQR 505.9–631.6) DOT per 1,000 days-present, respectively. In a hospital-level risk adjusted analysis, a hospital’s MRSA prevalance was significantly associated with its monthly use of both anti-MRSA and total antibiotics (IRR=1.05, 95% 1.02–1.07; IRR=1.02, 95% CI, 1.01–1.03). A 5% increase in the hospital’s MRSA prevalence was associated with an increase in the monthly use of anti-MRSA antibiotics and total antibiotics by 23.6 and 8.3 DOT per 1,000 days-present, respectively. Conclusion Higher hospital-level MRSA prevalence was associated with significantly higher rates of antibiotic utilization, even after adjusting for case-mix and reported antibiotic stewardship strategies. Future benchmarking of anti-MRSA antibiotic use across hospitals may need to risk-adjust using baseline rates of MRSA prevalence. Disclosures Daniel J. Livorsi, MD, MSc, Merck and Company, Inc (Research Grant or Support) Rajeshwari Nair, PhD, Merck and Company, Inc. (Research Grant or Support)

scholarly journals Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas D. Dieringer ◽  
Daisuke Furukawa ◽  
Christopher J. Graber ◽  
Vanessa W. Stevens ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

scholarly journals 2892. The Relationship Between Inpatient and Post-discharge Antimicrobial Use at the Hospital-level Across an Integrated Healthcare Network

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S79-S80
Author(s):  
Daniel J Livorsi ◽  
Jade Feller ◽  
Brian Lund ◽  
Bruce Alexander ◽  
Rajeshwari Nair ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Health Administration ◽  
Hospital Level ◽  
Post Discharge ◽  
Antimicrobial Prescribing ◽  
Days Of Therapy

Abstract Background Hospital-based antimicrobial stewardship interventions and metrics have typically focused only on inpatient antimicrobial exposure. However, single-center studies have found a large portion of antimicrobial exposure occurs immediately after hospital discharge. We sought to describe antimicrobial-prescribing upon hospital discharge across the Veterans Health Administration (VHA) and to compare inpatient and post-discharge antimicrobial use at the hospital-level. Methods This retrospective study used national VHA administrative data to identify all acute-care admissions from January 1, 2014 to December 31, 2016. Post-discharge antimicrobials were defined as oral outpatient antimicrobials prescribed at the time of hospital discharge. We measured inpatient-days of therapy (DOT) and post-discharge DOTs. At the hospital-level, inpatient DOTs per 100 admissions were compared with post-discharge DOTs per 100 admissions using Spearman’s rank-order correlation. Results Among 1.7 million acute-care admissions across 122 VHA hospitals, 46.1% were administered inpatient antimicrobials and 19.9% were prescribed an oral antimicrobial at discharge. Fluoroquinolones were the most common antimicrobial prescribed at discharge among 335,396 antimicrobial prescriptions (38.3%). At the hospital-level, median inpatient antimicrobial use was 331.3 DOTs per 100 admissions (interquartile range (IQR) 284.9–367.9) and median post-discharge use was 209.5 DOTs per 100 admissions (IQR 181.5–239.6). Thirty-nine percent of the total duration of antimicrobial exposure occurred after hospital discharge. The metrics of inpatient DOTs per 100 admissions and post-discharge DOTs per 100 admissions were weakly correlated at the hospital-level (rho = 0.44, P < 0.0001). Conclusion Antimicrobial-prescribing at hospital discharge was common and contributed substantially to the total antimicrobial exposure associated with an acute-care hospital stay. A hospital’s inpatient antimicrobial use was only weakly correlated with its post-discharge antimicrobial use. Antimicrobial stewardship interventions should specifically target antimicrobial-prescribing at discharge. Disclosures All Authors: No reported Disclosures.

scholarly journals Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

2020 ◽  
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Brian C Lund ◽  
Bruce Alexander ◽  
Brice F Beck ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antibiotic Stewardship ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Negative Binomial Regression Model ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Admissions ◽  
Days Of Therapy

Abstract Background Many US hospitals lack infectious disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist. Methods This retrospective VHA cohort included all acute-care patient admissions during 2016. A mandatory survey was used to identify hospitals’ antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy per days present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient admissions. Results Eighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525 451 (95.8%) admissions at ID hospitals and 23 007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use (odds ratio, 0.92; 95% confidence interval, .85–.99). Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials (0.61; .54–.70) and higher narrow-spectrum β-lactam use (1.43; 1.22–1.67). Total antibacterial exposure (inpatient plus postdischarge) was lower among patients at ID versus non-ID sites (0.92; .86–.99). Conclusions Patients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship.

Antibiotic Resistance in Long-Term Acute Care Hospitals The Perfect Storm

2006 ◽  
Vol 27 (9) ◽  
pp. 920-925 ◽  
Author(s):  
Carolyn V. Gould ◽  
Richard Rothenberg ◽  
James P. Steinberg
Keyword(s):  
Antibiotic Resistance ◽  
Acute Care ◽  
Methicillin Resistance ◽  
Horizontal Transmission ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Hospital Level ◽  
Medical Icus

Objective.To examine bacterial antibiotic resistance and antibiotic use patterns in long-term acute care hospitals (LTACHs) and to evaluate effects of antibiotic use and other hospital-level variables on the prevalence of antibiotic resistance.Design.Multihospital ecologic study.Methods.Antibiograms, antibiotic purchasing data, and demographic variables from 2002 and 2003 were obtained from 45 LTACHs. Multivariable regression models were constructed, controlling for other hospital-level variables, to evaluate the effects of antibiotic use on resistance for selected pathogens. Results of active surveillance in 2003 at one LTACH were available.Results.Among LTACHs, median prevalences of resistance for several antimicrobial-organism pairs were greater than the 90th percentile value for National Nosocomial Infections Surveillance system (NNIS) medical intensive care units (ICUs). The median prevalence of methicillin resistance amongStaphylococcus aureusisolates was 84%. More than 60% of patients in one LTACH were infected or colonized with methicillin-resistantS. aureusand/or vancomycin-resistantEnterococcusat the time of admission. Antibiotic consumption in LTACHs was comparable to consumption in NNIS medical ICUs. In multivariable logistic regression modeling, the only significant association between antibiotic use and the prevalence of antibiotic resistance was for carbapenems and imipenem resistance amongPseudomonas aeruginosaisolates (odds ratio, 11.88 [95% confidence interval, 1.42-99.13];P= .02).Conclusions.The prevalence of antibiotic resistance among bacteria recovered from patients in LTACHs is extremely high. Although antibiotic use in LTACHs likely contributes to resistance prevalence for some antimicrobial-organism pairs, for the majority of such pairs, other variables, such as prior colonization with and horizontal transmission of antimicrobial-resistant pathogens, may be more important determinants. Further research on antibiotic resistance in LTACHs is needed, particularly with respect to determining optimal infection control practices in this environment.

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

Quantifying Empiric Antibiotic Use in US Children’s Hospitals

2021 ◽  
Author(s):  
Kathleen Chiotos ◽  
Lauren D’Arinzo ◽  
Eimear Kitt ◽  
Rachael Ross ◽  
Jeffrey S. Gerber
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Level Variation ◽  
Hospital Level ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospitals ◽  
Broad Spectrum Antibiotics ◽  
Children’S Hospitals ◽  
Days Of Therapy ◽  
Rule Out

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

Abstract 116: Temporal Trends and Hospital-level Variation in the Incidence and 30-day Mortality of In-Hospital Cardiac Arrest within the Veterans Health Administration

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Steven M Bradley ◽  
Kyle M Kepreos ◽  
Paul S Chan ◽  
Theodore J Iwashyna ◽  
Brahmajee K Nallamothu
Keyword(s):  
Cardiac Arrest ◽  
Veterans Health Administration ◽  
Mortality Rates ◽  
Veterans Health ◽  
Health Administration ◽  
Level Variation ◽  
Hospital Level ◽  
Incidence And Mortality ◽  
Hospital Cardiac Arrest ◽  
Median Rate

Background: Improving the quality of in-hospital cardiac arrest (IHCA) care within the Veterans Health Administration (VHA) has received significant attention. Yet there are no national VHA data on the incidence and mortality outcomes of IHCA to guide or evaluate these efforts. We sought to determine overall trends and hospital-level variation in the incidence and 30-day mortality of IHCA within the VHA. Methods: Among 2,731,295 patients hospitalized at 115 VHA hospitals between 2008 and 2012, we defined IHCA using specific ICD-9 procedure codes for cardiac arrest and cardiopulmonary resuscitation. Among patients suffering IHCA, we used the VA Vital Status file to identify 30-day mortality from hospital admission. A severity of illness score was used to account for case-mix and determined from a logistic multivariate adaptive regression spline (MARS) model fit to our mortality outcome with covariates for age, race, gender, admission diagnosis category, 29 comorbid conditions, and 11 lab values drawn within 24 hours of admission. Hospital-level IHCA incidence and 30-day mortality rates were compared using empirical Bayes random effects estimates from multi-level regression models after risk- and reliability-adjustment. Results: 8,565 (0.3%) patients suffered IHCA between 2008 and 2012 and there was no significant trend in the rate of IHCA over this time period. The hospital-level incidence of IHCA varied and was statistically significantly higher than the median rate at 38 (34%) hospitals and significantly lower at 24 (21%) hospitals (Figure A, p<0.05 without adjustment for multiple comparisons). Among patients suffering IHCA, the overall 30-day mortality rate was 68.6% and the risk-adjusted 30-day mortality rate decreased from 71.2% in 2008 to 66.1% in 2012 (p for trend <0.01). Hospital-level 30-day mortality was significantly higher than the median rate at 5 (4%) hospitals and significantly lower at 7 (6%) hospitals (Figure B). Conclusions: Within the VHA, the incidence of IHCA has remained stable while 30-day mortality has improved. However, hospital-level variation in IHCA incidence and mortality rates suggest variation in care processes related to IHCA and a target for future investigation to improve patient outcomes.

scholarly journals Automated Nationwide Benchmarking Dashboard for Antimicrobial Stewardship Programs within the Veterans’ Health Administration

2021 ◽  
Vol 1 (S1) ◽  
pp. s23-s24
Author(s):  
Michihiko Goto ◽  
Eli Perencevich ◽  
Alexandre Marra ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Risk Adjustment ◽  
Long Term Care ◽  
Antimicrobial Use ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Patient Level

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.Funding: NoDisclosures: None

scholarly journals 785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S437
Author(s):  
Kerui Xu ◽  
Andrea L Benin ◽  
Hsiu Wu ◽  
Jonathan R Edwards ◽  
Qunna Li ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Prevalence Rates ◽  
Hospital Level ◽  
First Line ◽  
Oral Vancomycin ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Methods We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted &lt; 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs. Results Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63). Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs Conclusion The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document