scholarly journals 171. A Multicenter Analysis of Inpatient Antibiotic Use During the 2015-2019 Influenza Season in the US: Untapped Opportunities for Antimicrobial Stewardship

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Amine Amiche ◽  
Heidi Kabler ◽  
Janet Weeks ◽  
Kalvin Yu ◽  
Vikas Gupta
Keyword(s):  
Antimicrobial Stewardship ◽  
Influenza Season ◽  
Random Effect ◽  
Laboratory Data ◽  
The United States ◽  
Research Database ◽  
Becton Dickinson ◽  
Days Of Therapy ◽  
Trends Over Time ◽  
Over Time

Abstract Background Inappropriate antibiotic (AB) use for viral respiratory illnesses remains widespread in the United States (US) with strong seasonal fluctuations. In contrast to outpatient AB use, the seasonality inpatient AB utilization (IAU) and its correlation with the influenza season are not well understood. We sought to describe trends, seasonality, and the association between IAU use and the 2015-2019 influenza seasons. Methods We used the BD Insights Research Database (Franklin Lakes, NJ USA) to identify IAU that were prescribed in patients >17 years old from up to 236 US acute care facilities from July 2015 to December 2019. We included the following AB categories: extended spectrum cephalosporins (ESCs), macrolides, β-lactam inhibitor combination (BLIC), fluoroquinolones, carbapenems, glycopeptides, lipopeptide, tetracyclines, and others. We defined IAU use as days of therapy (DOT) per 1000 patient days present. We used influenza laboratory data to identify facility-level positivity ratio per 100 tests. We used random effect models to estimate IAU: 1) trends overtime, 2) seasonality, and 3) association with influenza positivity rate. Results For IAU from 2015 to 2019, BLICs, ESCs, and glycopeptides were the most used [average 91, 107, and 96 DOT/1000 days presents, respectively]. Visually, we observed strong seasonality that matches the influenza season for macrolide, ESC, and quinolone use (See Figure). Unadjusted bivariate results showed ascending trends over time for BLICs [β= 3.8, p= .003], ESCs [β= 11.0, p= .005], and macrolides [β=1.5, p= .005]. Unadjusted bivariate results showed descending trends with quinolones [β= -10.9, p< .001] and others [β= -2.060, p< .001]. In the adjusted analysis, increased influenza positivity rate was associated with use of ESCs, glycopeptides, lipopeptides, macrolides, fluoroquinolone, and tetracyclines (see Table). No correlation was observed with BLICs, carbapenems, lipopeptides, and Others. IAU (DOT/1000 days presents) and Flu Rate (% Positive) Trends Over Time Conclusion Our study shows that IAU is on the rise for the ESC and BLIC classes. ESC and macrolide use was strongly correlated with influenza season. Monitoring influenza signals may provide more insights that can inform the interpretation of IAU trends and be incorporated into antimicrobial stewardship programs. Disclosures Amine Amiche, PhD, Sanofi (Employee, Shareholder) Heidi Kabler, MD, Sanofi Pasteur (Employee) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)

scholarly journals 176. Antibiotic Resistance Patterns, Seasonality, and Correlation with the Influenza Season in the United States: A Multicenter Evaluation Reveals Surprising Association Between Influenza Season and Gram Negative Pathogens

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S108-S108
Author(s):  
Amine Amiche ◽  
Heidi Kabler ◽  
Janet Weeks ◽  
Kalvin Yu ◽  
Vikas Gupta
Keyword(s):  
United States ◽  
Influenza Season ◽  
Influenza Infection ◽  
The United States ◽  
P Value ◽  
Research Database ◽  
Becton Dickinson ◽  
Gram Negative ◽  
Resistance Patterns ◽  
Inpatient Settings

Abstract Background Influenza infection may affect bacterial transmission dynamics and seasonality of antimicrobial resistance (AMR). There is a paucity of data on the association of influenza season and AMR rates. We aimed to describe trends of AMR and their correlation with the influenza season in ambulatory and inpatient settings in the United States (US). Methods We used the BD Insights Research Database (Franklin Lakes, NJ USA) to identify 30 day non-duplicate isolates collected from patients >17 years old with susceptibility profile of Gram-negative (GN) (Enterobacterales (ENT), P. aeruginosa (PSA), A. baumannii spp. (ACB), and S. maltophilia (Sm)) and Gram-positive (GP) pathogens (S. aureus (SA), and S. pneumoniae (Sp)) in up to 257 US healthcare institutions from 2011-19. We defined the outcomes as rates per 100 admissions and % of non-susceptibility (NS), stratified by community and inpatient settings, resistance type (resistance to carbapenem (Carb-NS), quinolone (FQ-NS), macrolide (Macr NS), penicillin (PCN NS), and extended spectrum cephalosporin (ESC NS)) and isolate origin (respiratory and non-respiratory). Influenza data were presented as the % of positive laboratory tests. We used descriptive statistics and generalized estimating equations models to evaluate the monthly trends of AMR outcomes and correlation with the influenza season. Results We identified 16 576 274 confirmed non-duplicate pathogens, of which 154 841 were GN Carb-NS, 1 502 796 GN FQ-NS, 498 012 methicillin resistant SA (MRSA), and 44 131 Macr-NS, PCN-NS, and ESC-NS Sp. Among the Carb-NS pathogens, Influenza rate was correlated with % ACB-NS [β= 0.205, p< .001]. In the FQ-NS group, influenza was associated with overall % ENT-NS [β= 0.041 p< .001] and % PSA-NS [β= 0.039, p = .015]. For the GP pathogens, all Sp. rates were correlated with increased influenza positivity % (See Table). Only MRSA rates of respiratory source were associated with influenza [β= .066, p=.028]. Summary of Multivariate regressions of AMR and % Flu by Source and Setting (controlling for hospital level factors): 2011-2019 Data in each cell is presented as the coefficient and p-value is in parentheses. ^adjusted for region, teaching, urban, bed size, and season. + p<.10 *p <.05 **p <.01 ***p <.001 Conclusion Our study revealed surprising association between influenza epidemics and GN resistance and corroborated the evidence of correlation between respiratory GP and influenza infections. These insights may help inform targeted antimicrobial stewardship initiatives during influenza season. Disclosures Amine Amiche, PhD, Sanofi (Employee, Shareholder) Heidi Kabler, MD, Sanofi Pasteur (Employee) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)

scholarly journals Trends over time in enrollment in non-group health insurance plans by tobacco use in the United States

2017 ◽  
Vol 7 ◽  
pp. 46-49 ◽  
Author(s):  
Michael F. Pesko ◽  
Johanna Catherine Maclean ◽  
Cameron M. Kaplan ◽  
Steven C. Hill
Keyword(s):  
United States ◽  
Health Insurance ◽  
Tobacco Use ◽  
The United States ◽  
Group Health ◽  
Trends Over Time ◽  
Group Health Insurance ◽  
Over Time

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

2012 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Andrew M. Morris ◽  
Stacey Brener ◽  
Linda Dresser ◽  
Nick Daneman ◽  
Timothy H. Dellit ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Public Reporting ◽  
Modified Delphi ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

scholarly journals Trends over Time in Adolescent Emotional Wellbeing in the Netherlands, 2005-2017: Links with Perceived Schoolwork Pressure, Parent-Adolescent Communication and Bullying Victimization

2020 ◽  
Vol 49 (10) ◽  
pp. 2124-2135
Author(s):  
M. E. De Looze ◽  
A. P. Cosma ◽  
W. A. M. Vollebergh ◽  
E. L. Duinhof ◽  
S. A. de Roos ◽  
...  
Keyword(s):  
The Netherlands ◽  
The United States ◽  
High Income ◽  
Bullying Victimization ◽  
Emotional Wellbeing ◽  
Emotional Symptoms ◽  
Cross Sectional ◽  
Dutch Health ◽  
Trends Over Time ◽  
Over Time

Abstract In some Scandinavian countries, the United Kingdom and the United States, there is evidence of a dramatic decline in adolescent emotional wellbeing, particularly among girls. It is not clear to what extent this decline can be generalised to other high-income countries. This study examines trends over time (2005-2009-2013-2017) in adolescent wellbeing in the Netherlands, a country where young people have consistently reported one of the highest levels of wellbeing across Europe. It also assesses parallel changes over time in perceived schoolwork pressure, parent-adolescent communication, and bullying victimization. Data were derived from four waves of the nationally representative, cross-sectional Dutch Health Behaviour in School-aged Children study (N = 21,901; 49% girls; Mage = 13.78, SD = 1.25). Trends in emotional wellbeing (i.e., emotional symptoms, psychosomatic complaints, life satisfaction) were assessed by means of multiple regression analyses with survey year as a predictor, controlling for background variables. Emotional wellbeing slightly declined among adolescent boys and girls between 2009 and 2013. A substantial increase in perceived schoolwork pressure was associated with this decline in emotional wellbeing. Improved parent-adolescent communication and a decline in bullying victimization may explain why emotional wellbeing remained stable between 2013 and 2017, in spite of a further increase in schoolwork pressure. Associations between emotional wellbeing on the one hand and perceived schoolwork pressure, parent-adolescent communication, and bullying victimization on the other were stronger for girls than for boys. Overall, although increasing schoolwork pressure may be one of the drivers of declining emotional wellbeing in adolescents, in the Netherlands this negative trend was buffered by increasing support by parents and peers. Cross-national research into this topic is warranted to examine the extent to which these findings can be generalised to other high-income countries.

US academic libraries' staffing and expenditure trends (1996–2016)

2020 ◽  
Vol 41 (4/5) ◽  
pp. 247-268 ◽  
Author(s):  
Starr Hoffman ◽  
Samantha Godbey
Keyword(s):  
Academic Libraries ◽  
The United States ◽  
Data Sets ◽  
Size Category ◽  
Data Set ◽  
Content Type ◽  
Education Statistics ◽  
Trends Over Time ◽  
Doctoral Institutions ◽  
Over Time

PurposeThis paper explores trends over time in library staffing and staffing expenditures among two- and four-year colleges and universities in the United States.Design/methodology/approachResearchers merged and analyzed data from 1996 to 2016 from the National Center for Education Statistics for over 3,500 libraries at postsecondary institutions. This study is primarily descriptive in nature and addresses the research questions: How do staffing trends in academic libraries over this period of time relate to Carnegie classification and institution size? How do trends in library staffing expenditures over this period of time correspond to these same variables?FindingsAcross all institutions, on average, total library staff decreased from 1998 to 2012. Numbers of librarians declined at master’s and doctoral institutions between 1998 and 2016. Numbers of students per librarian increased over time in each Carnegie and size category. Average inflation-adjusted staffing expenditures have remained steady for master's, baccalaureate and associate's institutions. Salaries as a percent of library budget decreased only among doctoral institutions and institutions with 20,000 or more students.Originality/valueThis is a valuable study of trends over time, which has been difficult without downloading and merging separate data sets from multiple government sources. As a result, few studies have taken such an approach to this data. Consequently, institutions and libraries are making decisions about resource allocation based on only a fraction of the available data. Academic libraries can use this study and the resulting data set to benchmark key staffing characteristics.

scholarly journals 398. Multicenter Evaluation of Outcomes of SARS-CoV-2 Positive Patients Treated at Rural vs Urban Hospitals in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S301-S301
Author(s):  
Karri A Bauer ◽  
Kalvin Yu ◽  
Vikas Gupta ◽  
Laura A Puzniak
Keyword(s):  
Cohort Analysis ◽  
The United States ◽  
Hospitalized Patients ◽  
Rural Hospital ◽  
Research Database ◽  
Urban Hospital ◽  
Becton Dickinson ◽  
Urban Hospitals ◽  
Rural And Urban ◽  
The Us

Abstract Background The SARS-CoV-2 pandemic has revealed socioeconomic and healthcare inequities in the US. With approximately 20% of the population living in rural areas, there are limitations to healthcare access due to economic constraints, geographical distances, and provider shortages. There is limited data evaluating outcomes associated with SARS-CoV-2 positive patients treated at rural vs. urban hospitals. The aim of the study was to evaluate characteristics and outcomes of SARS-CoV-2 positive patients treated at rural vs. urban hospitals in the US. Methods This was a multicenter, retrospective cohort analysis of adult (≥ 18 years) hospitalized patients from 241 US acute care facilities with >1 day inpatient admission with a discharge or death between 3/6/20-5/15/21 (BD Insights Research Database [Becton, Dickinson & Company, Franklin Lakes, NJ]), which includes both small and large hospitals in rural and urban areas. SARS-CoV-2 infection was identified by a positive PCR or antigen during or < 7 days prior to hospital admission. Descriptive statistics were completed. P value of ≤0.05 was considered statistically significant. Results Overall, 42 (17.4%) and 199 (82.6%) of hospitals were classified as rural and urban, respectively. A total of 304,073 patients were admitted to a rural hospital with 12,644 (4.2%) SARS-CoV-2 positive. In comparison, a total of 2,844,100 patients were treated at an urban hospital with 132,678 (4.7%) SARS-CoV-2 positive. Patients admitted to rural hospitals were older compared to those treated at an urban hospital (65.2 ± 17.3 vs. 61.5 ± 18.7, P=0.001) (Table 1). Patients treated at an urban facility had significantly higher rates of ICU admission, severe sepsis, and mechanical ventilation. ICU length of stay was significantly longer for patients admitted to an urban hospital compared to a rural hospital (8.1 ± 9.9 vs. 6.1 ±7.2 days, P=0.001) (Table 2). No difference in mortality was observed. Table 1. Characteristics of SARS-CoV-2 positive patients treated at rural vs. urban hospitals. Table 2. Outcomes of SARS-CoV-2 patients treated at rural vs. urban hospitals. *Patients with available data. Conclusion In this large multicenter evaluation of hospitalized patients positive for SARS-CoV-2, there were significant differences in patient characteristics. There was no observed difference in mortality. These findings are important in evaluating the pandemic’s impact on patients in rural and urban healthcare settings. Disclosures Karri A. Bauer, PharmD, Merck & Co., Inc. (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee)

scholarly journals Trends in Instrument Flight Rules (IFR) Conditions at Major Airports in the United States

2019 ◽  
Vol 58 (3) ◽  
pp. 615-620 ◽  
Author(s):  
Scott E. Stevens
Keyword(s):  
United States ◽  
The United States ◽  
Meteorological Conditions ◽  
Low Visibility ◽  
Timely Fashion ◽  
Trends Over Time ◽  
Over Time ◽  
Surface Observations

AbstractWeather-related delays are among the most common in aviation and are frequently the result of low visibility or cloud ceilings, which cause landing aircraft to be spaced farther apart for safety, reducing the capacity of an airport to land aircraft in a timely fashion. Using 45 years of archived surface observations from 30 of the busiest airports across the United States, the prevalence of low-visibility and low-ceiling conditions is examined, along with the meteorological conditions that support them and the associated trends over time. It is shown that these conditions are becoming less frequent at most locations—for many significantly so—and that this decrease can be seen at all times of day and in all seasons.

scholarly journals 1485. Trends in Important-Resistant Gram-Negative (GN) and Gram-Positive (GP) Urine Bacterial Pathogens in Hospitalized Patients in the United States: A Multicenter Evaluation from 2013 to 2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S541-S541
Author(s):  
Thomas Lodise ◽  
Steven P Gelone ◽  
Kalvin Yu ◽  
Kalpana Gupta ◽  
Maureen Early ◽  
...  
Keyword(s):  
The United States ◽  
Generation Cephalosporin ◽  
Hospitalized Patients ◽  
Research Database ◽  
Becton Dickinson ◽  
Antibiotic Resistant ◽  
Carbapenem Resistant ◽  
Time Period ◽  
Positive Urine ◽  
Notable Increase

Abstract Background The US CDC has identified a number of antibiotic-resistant (AR) bacteria as urgent or serious public health threats. This study sought to quantify the prevalence and incidence of extended-spectrum β-lactamase (ESBL) Enterobacteriaceae (ENT), Carbapenem-resistant ENT (CRE), P. aeruginosa (Carb NS-PsA), vancomycin-resistant enterococci (VRE), and methicillin-resistant S. aureus (MRSA) in the urine of adult hospitalized patients. Methods All hospitalized adult patients with a positive urine culture (first urine isolate of a species per 30-day period) were evaluated from over 400 US hospitals (2013–2018; BD Insights Research Database, Becton, Dickinson and Company). The following five groups of AR bacteria were examined: (1) ESBL ENT if ESBL-positive per commercial panels or intermediate/resistant (non-susceptible [NS]) to a third-generation cephalosporin; (2) CRE ENT if NS to imipenem (IPM), meropenem (MEM), doripenem (DOR) or ertapenem; (3) Carb-NS PsA if NS to IPM, MEM or DOR; (4) VRE if resistant to vancomycin; and (5) MRSA as resistant to methicillin/oxacillin. For each AR grouping, % NS and rates of NS per 100 admissions were calculated and trends were examined using Logistic regression and Poisson models. Results Across the 6-year study period, there were 24,558,856 admissions, accounting for 2,285,971 non-duplicate urine isolates; 1,016,642 were ENT, 87,450 were PSA, 203,231 were enterococci, and 41,979 were S. aureus. The % of NS for ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA were 12%, 0.9%, 13%, 19%, and 55%, respectively. The % of NS for ESBL increased from 2013 to 2018 (P < 0.001) whereas % NS for PsA and % MRSA decreased during the same time period (P < 0.001) (Figure 1). The rates of NS per 100 admissions for ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA were 0.44, 0.04, 0.05, 0.16, and 0.09, respectively. The annual NS rates per 100 admission trends for ESBL and CRE ENT were increasing (all P < 0.0001) while the trends for Carb-NS PsA, VRE, and MRSA were decreasing (all P < 0.0001). Conclusion While the percent of ESBL, CRE ENT, Carb-NS PsA, VRE, and MRSA have remained relatively constant over the past 6 years, there has been a notable increase in the rates of ESBL and CRE ENT per 100 admissions among adult hospitalized patients with positive urine cultures. Disclosures All authors: No reported disclosures.

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