169. Prevalence and Associated Patient Characteristics of Multi-Drug Resistant Organisms and Antibiotic Prescribing Patterns in Hospitalized Patients with Community-Acquired Pneumonia

Abstract Background The 2019 Infectious Diseases Society of America/American Thoracic Society community-acquired pneumonia (CAP) guidelines eliminated the term healthcare-associated pneumonia (HCAP), and recommends to guide the use of broad-spectrum antibiotics by locally validating the prevalence and risk factors of multi-drug resistant organisms (MDROs). The objective of this study is to determine the prevalence and associated patient characteristics of MDROs, and to characterize antibiotic prescribing patterns. Methods This was a retrospective, cohort study in adult patients hospitalized from 1/1/19 to 12/31/19. Patients were randomly selected from a patient list of diagnosis codes suggestive of pneumonia. We excluded patients with antibiotic therapy < 48 hours, bacterial co-infections from another site, or transferred from another hospital with length of stay >24 hours. Endpoints evaluated include the percentage of MDRO isolated from a respiratory or blood culture collected within 2 days of admission, comparison of patient characteristics associated with MDROs with those who did not, treatment regimen and duration, and rate of overtreatment and undertreatment. Results A total of 220 patients were included. Prevalence of overall MDRO, methicillin-resistant Staphylococcus aureus (MRSA), and Pseudomonas aeruginosa (PSA) was 8%, 3%, and 5%, respectively. Patient characteristics associated with MDROs from are shown in Table 1. Prior MDRO history or recent intravenous (IV) antibiotic exposure during hospitalization was present in 39% of the MDRO cohort. Over half (58%) of the patients were initiated on antibiotics with MRSA and/or PSA coverage. Rate of overtreatment and undertreatment was 89% and 5%, respectively. Mean antibiotic duration was 9 ± 3 days. Conclusion The low prevalence of MDROs, coupled with the high overtreatment and low undertreatment rate suggests most patients hospitalized with CAP at our institution can receive an antibiotic regimen targeting standard CAP pathogens. Antibiotic stewardship intervention to shorten the duration of therapy should be considered. In addition to microbiology history and recent IV antibiotic exposure during hospitalization, further studies are needed to validate other patient characteristics at risk for MDROs. Disclosures All Authors: No reported disclosures

Download Full-text

Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx088 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 6

Author(s):

Sara Tomczyk ◽

Seema Jain ◽

Anna M Bramley ◽

Wesley H Self ◽

Evan J Anderson ◽

...

Keyword(s):

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Community Study ◽

Antibiotic Prescribing ◽

Beta Lactam ◽

First Line ◽

Factors Associated ◽

Admission Ward ◽

Healthcare Associated ◽

To Receive

Abstract Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. Methods From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. Results Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. Conclusions Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

Download Full-text

Utilizing Pharmacy Records to Assess Antibiotic Prescribing Patterns on the Incidence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-12.2.91 ◽

2007 ◽

Vol 12 (2) ◽

pp. 91-101

Author(s):

Peter N. Johnson ◽

Robert P. Rapp ◽

Christopher T. Nelson ◽

J.S. Butler ◽

Sue Overman ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Therapy ◽

Methicillin Resistant Staphylococcus Aureus ◽

Prescribing Patterns ◽

Control Group ◽

Antibiotic Prescribing ◽

Antibiotic Exposure ◽

Pharmacy Records ◽

Methicillin Resistant ◽

Prior Antibiotic Therapy

OBJECTIVE To assess the effect of prior antibiotic therapy on the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children. METHODS This was a concurrent and retrospective review of antibiotic records for children < 18 years of age with documented CA-MRSA infection identified between January 1, 2004, and December 31, 2005. Antibiotic records were compared against a control group. The primary outcome was the incidence of CA-MRSA using linear regression as a function of age and prior antibiotic therapy (i.e., 3 months prior to admission). Secondary objectives included a comparison of antibiotic courses and classes and a description of antibiotic susceptibilities in patients with CA-MRSA RESULTS Data from 26 patients were included. Nine out of 51 patients (18%) with CA-MRSA were included. Another 17 children were enrolled in the control group. The median age was approximately 1.75 years (0.08–14 years) in the CA-MRSA group versus 2.75 years (0.005-15 years) in the control group. A statistical difference was noted in the number of patients with prior antibiotic exposure between the CA-MRSA and control group, 8 (88.9%) versus 6 (35.3%), respectively (P = .01). Antibiotic exposure was found to be a significant independent risk factor (P = .005; 95% CI, 0.167–0.846) for the development of CA-MRSA. The interaction between antibiotic exposure and age < 3 was the most significant predictor of CA-MRSA (P = .019; 95% CI, 0.139–1.40). CONCLUSIONS Prior antibiotic therapy in patients < 3 years of age was associated with a significant risk of developing CA-MRSA. A comprehensive assessment of CA-MRSA patients should include objective methods of measuring prior antibiotic exposure such as pharmacy records.

Download Full-text

Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Community Acquired Pneumonia ◽

Drug Resistant ◽

Hospital Acquired Pneumonia ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Hospital Acquired

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

Download Full-text

2193. Factors Impacting the Duration of Antimicrobial Therapy for Community-Acquired Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1873 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S746-S747

Author(s):

Avnish Sandhu ◽

Erin Goldman ◽

Jordan Polistico ◽

Sarah Polistico ◽

Ahmed Oudeif ◽

...

Keyword(s):

Risk Factors ◽

Medical Center ◽

Clinical Signs ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Community Acquired Pneumonia ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Factors Associated ◽

Specific Risk

Abstract Background Pneumonia is a common cause of infection associated with hospitalization. Treatment durations for community-acquired pneumonia (CAP) often exceed guideline recommended durations of 5–7 days without a clear explanation. The objective of this study was to determine factors that may lead to durations exceeding this recommendation. Methods A retrospective chart review of 89 patients admitted to the Detroit Medical Center (DMC) for the treatment of pneumonia was conducted. Demographics, clinical signs and symptoms, antibiotic data, pneumonia severity score (CURB 65), risk factors for resistance, microbiology results, and outcomes were recorded and analyzed for factors associated with increased durations of antibiotics. Average durations of antibiotics and durations of antibiotics greater that 7 days were assessed for each risk factor. Results Average durations of antibiotics was 9 days (SD 3.8) for the cohort, and 55 (61%) received durations of > 7 days. Average durations of antibiotics for risk factors are shown in Table 1. Factors associated with durations of antibiotics longer than 7 days are shown in Table 2. There was a trend toward longer average durations of antibiotics for persons with risk factors for resistance [Drug Resistance in Pneumonia (DRIP) score ≥ 4 (increased duration of antibiotics by 1.7 days, P = 0.07] and those with a positive legionella antigen [increased durations of antibiotics by 6.6 days, P = 0.07]. Conclusion Specific risk factors could not be associated with increased durations of antibiotics, although there was a trend toward longer durations for persons with markers for resistance and positive legionella testing. Efforts to reduce durations of antibiotics must target global clinician antibiotic prescribing patterns and not specific risk factors. Disclosures All authors: No reported disclosures.

Download Full-text

Antibiotics Utilization for Community Acquired Pneumonia in a Community Hospital Emergency Department

Journal of Pharmacy Practice ◽

10.1177/0897190020953032 ◽

2020 ◽

pp. 089719002095303

Author(s):

Jessica Yu ◽

Gillian Wang ◽

Ann Davidson ◽

Ivy Chow ◽

Ada Chiu

Keyword(s):

Emergency Department ◽

Community Hospital ◽

Community Acquired Pneumonia ◽

Antibiotic Usage ◽

Prescribing Patterns ◽

Local Health Authority ◽

Antibiotic Prescribing ◽

Local Health ◽

Moderate Severity ◽

Stewardship Program

Background: A local health authority in Canada implemented its own Antimicrobial Stewardship Program (ASP) which provide guidelines to clinicians to utilize when treating infectious diseases such as community-acquired pneumonia (CAP). Objectives: The primary objective is to describe antibiotic usage patterns at the community hospital’s emergency department (ED) and to analyze the patterns in relation to ASP goals of reducing risk of infections, adverse drug events and antibiotic resistance, and to identify potential areas of improvement. Methods: This retrospective chart review included 156 adult patients with a diagnosis of CAP admitted to a community hospital ED from December 1, 2015 to November 30, 2016. Results: 50.6% patients were prescribed moxifloxacin across all severity of CAP patients. Low and moderate severity CAP patients were most often prescribed antibiotic duration > 7 days. In low, moderate and high severity CAP patients who were treated using ceftriaxone, 100%, 88.9% and 66.6% patients were treated with ceftriaxone 2000 mg daily respectively. Conclusions: Antibiotic prescribing patterns suggest fluoroquinolones were frequently being over-prescribed, ceftriaxone dosages were often too high, and duration of antibiotics for low and moderate severity CAP were too long. More efforts are needed to promote appropriate antibiotic usage and optimize patient care.

Download Full-text

Burden of Ambulatory Visits and Antibiotic Prescribing Patterns for Adults With Community-Acquired Pneumonia in the United States, 1998 Through 2009

JAMA Internal Medicine ◽

10.1001/jamainternmed.2014.3456 ◽

2014 ◽

Vol 174 (9) ◽

pp. 1520 ◽

Cited By ~ 8

Author(s):

Jonathan M. Wortham ◽

Daniel J. Shapiro ◽

Adam L. Hersh ◽

Lauri A. Hicks

Keyword(s):

United States ◽

The United States ◽

Community Acquired Pneumonia ◽

Prescribing Patterns ◽

Antibiotic Prescribing

Download Full-text

Diarrhoea and preadmission antibiotic exposure in COVID-19: a retrospective cohort study of 1153 hospitalised patients

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000593 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000593

Author(s):

Bilal Akhter Mateen ◽

Sandip Samanta ◽

Sebastian Tullie ◽

Sarah O’Neill ◽

Zillah Cargill ◽

...

Keyword(s):

Mortality Risk ◽

Antibiotic Use ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Antibiotic Exposure ◽

Test Results ◽

Risk Of Mortality ◽

Hospitalised Patients ◽

Increased Risk ◽

Residual Confounding

ObjectiveThe aims of this study were to describe community antibiotic prescribing patterns in individuals hospitalised with COVID-19, and to determine the association between experiencing diarrhoea, stratified by preadmission exposure to antibiotics, and mortality risk in this cohort.Design/methodsRetrospective study of the index presentations of 1153 adult patients with COVID-19, admitted between 1 March 2020 and 29 June 2020 in a South London NHS Trust. Data on patients’ medical history (presence of diarrhoea, antibiotic use in the previous 14 days, comorbidities); demographics (age, ethnicity, and body mass index); and blood test results were extracted. Time to event modelling was used to determine the risk of mortality for patients with diarrhoea and/or exposure to antibiotics.Results19.2% of the cohort reported diarrhoea on presentation; these patients tended to be younger, and were less likely to have recent exposure to antibiotics (unadjusted OR 0.64, 95% CI 0.42 to 0.97). 19.1% of the cohort had a course of antibiotics in the 2 weeks preceding admission; this was associated with dementia (unadjusted OR 2.92, 95% CI 1.14 to 7.49). After adjusting for confounders, neither diarrhoea nor recent antibiotic exposure was associated with increased mortality risk. However, the absence of diarrhoea in the presence of recent antibiotic exposure was associated with a 30% increased risk of mortality.ConclusionCommunity antibiotic use in patients with COVID-19, prior to hospitalisation, is relatively common, and absence of diarrhoea in antibiotic-exposed patients may be associated with increased risk of mortality. However, it is unclear whether this represents a causal physiological relationship or residual confounding.

Download Full-text

Emergence of Multidrug Resistance in Bacteria and Impact on Antibiotic Expenditure at a Major Army Medical Center Caring for Soldiers Wounded in Iraq and Afghanistan

Infection Control and Hospital Epidemiology ◽

10.1086/588702 ◽

2008 ◽

Vol 29 (7) ◽

pp. 661-663 ◽

Cited By ~ 10

Author(s):

Michael J. Zapor ◽

Daniel Erwin ◽

Goldina Erowele ◽

Glenn Wortmann

Keyword(s):

Medical Center ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Walter Reed Army Medical ◽

Gram Negative Bacteria ◽

Drug Resistant ◽

Gram Negative ◽

Army Medical ◽

Resistant Strains ◽

Drug Resistant Strains

Since the invasions of Iraq and Afghanistan, the epidemiologic traits of clinical isolates at Walter Reed Army Medical Center have shifted toward drug-resistant strains of microorganisms, particularly among the gram-negative bacteria. Moreover, antibiotic prescribing patterns during this period have changed remarkably and mirror the emergence of these organisms at our institution.

Download Full-text

Antibiotic prescribing patterns among patients admitted to an academic teaching hospital for COVID-19 during the first wave of the pandemic in Toronto: A retrospective, controlled study

Official Journal of the Association of Medical Microbiology and Infectious Disease Canada ◽

10.3138/jammi-2021-0020 ◽

2021 ◽

Author(s):

Miranda So ◽

Andrew M Morris ◽

Alexander M Walker

Keyword(s):

Antibiotic Use ◽

Antibiotic Consumption ◽

Community Acquired Pneumonia ◽

Prescribing Patterns ◽

Secondary Outcome ◽

Controlled Study ◽

Antibiotic Prescribing ◽

General Internal ◽

Days Of Therapy ◽

Empirical Antibiotics

Background: Empirical antibiotics are not recommended for coronavirus disease 2019 (COVID-19). Methods: In this retrospective study, patients admitted to Toronto General Hospital’s general internal medicine from the emergency department for COVID-19 between March 1 and August 31, 2020 were compared with those admitted for community-acquired pneumonia (CAP) in 2020 and 2019 in the same months. The primary outcome was antibiotics use pattern: prevalence and concordance with COVID-19 or CAP guidelines. The secondary outcome was antibiotic consumption in days of therapy (DOT)/100 patient-days. We extracted data from electronic medical records. We used logistic regression to model the association between disease and receipt of antibiotics, linear regression to compare DOT. Results: The COVID-19, CAP 2020, and CAP 2019 groups had 67, 73, and 120 patients, respectively. Median age was 71 years; 58.5% were male. Prevalence of antibiotic use was 70.2%, 97.3%, and 90.8% for COVID-19, CAP 2020, and CAP 2019, respectively. Compared with CAP 2019, the adjusted odds ratio (aOR) for receiving antibiotics was 0.23 (95% CI 0.10 to 0.53, p = 0.001) and 3.42 (95% CI 0.73 to 15.95, p = 0.117) for COVID-19 and CAP 2020, respectively. Among patients receiving antibiotics within 48 hours of admission, compared with CAP 2019, the aOR for guideline-concordant combination regimens was 2.28 (95% CI 1.08 to 4.83, p = 0.031) for COVID-19 and 1.06 (95% CI 0.55 to 2.05, p = 0.856) for CAP-2020. Difference in mean DOT/100 patient-days was –24.29 ( p = 0.009) comparing COVID-19 with CAP 2019, and +28.56 ( p = 0.003) comparing CAP 2020 with CAP 2019. Conclusions: There are opportunities for antimicrobial stewardship to address unnecessary antibiotic use.

Download Full-text