scholarly journals Changes in Broad-Spectrum Antibiotic Use Following Implementation of the CMS Sepsis (SEP-1) Measure in Select Locations Reporting to NHSN’s Antibiotic Use Option

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S512-S513
Author(s):  
Erin O’Leary ◽  
Jonathan R Edwards ◽  
Katharina Van Santen ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic

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.

Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards

Infection ◽  
2017 ◽  
Vol 45 (4) ◽  
pp. 493-504 ◽  
Author(s):  
Katharina Kreitmeyr ◽  
Ulrich von Both ◽  
Alenka Pecar ◽  
Johannes P. Borde ◽  
Rafael Mikolajczyk ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic

Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

2021 ◽  
pp. 001857872110557
Author(s):  
Jessica L. Colmerauer ◽  
Kristin E. Linder ◽  
Casey J. Dempsey ◽  
Joseph L. Kuti ◽  
David P. Nicolau ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Intervention Period ◽  
Provider Education ◽  
Broad Spectrum Antibiotic ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Days Of Therapy ◽  
Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

BROAD-SPECTRUM ANTIBIOTIC USE IN THE FIRST SIX MONTHS OF LIFE INCREASES RISK FOR PEDIATRIC ATOPIC ASTHMA

Epidemiology ◽  
2003 ◽  
Vol 14 (Supplement) ◽  
pp. S88 ◽  
Author(s):  
C C Johnson ◽  
D R Ownby ◽  
S H Alford ◽  
S L Havstad ◽  
C LM Joseph ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Atopic Asthma ◽  
Broad Spectrum Antibiotic

scholarly journals Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit

2006 ◽  
Vol 18 (3) ◽  
pp. 224-231 ◽  
Author(s):  
Karin A. Thursky ◽  
Kirsty L. Buising ◽  
Narin Bak ◽  
Lachlan Macgregor ◽  
Alan C. Street ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Broad Spectrum ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic ◽  
Computerized Decision Support

scholarly journals 226. Evaluating the Unnecessary Use of Intravenous Broad-Spectrum Antibiotics in Patients Based on Systemic Inflammatory Response Syndrome Criteria in the Emergency Department (ED)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S114-S114
Author(s):  
Esther Y Bae ◽  
Marguerite Monogue ◽  
Tiffeny T Smith
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Bacterial Infection ◽  
Broad Spectrum ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Systemic Inflammatory Response ◽  
Broad Spectrum Antibiotic ◽  
Suspected Sepsis ◽  
Broad Spectrum Antibiotics

Abstract Background Recognition of sepsis frequently occurs in the ED. To demonstrate the need to optimize antibiotic use for suspected sepsis and evaluate the reliability of systemic inflammatory response syndrome (SIRS) criteria in predicting bacterial infection, we quantified the rate of unnecessary intravenous (IV) broad-spectrum antibiotic use for suspected sepsis in the ED at an academic medical center. Methods Adult patients who were admitted to the ED between January 2018 and June 2018 with suspected sepsis (≥ 2 SIRS) and received ≥ 1 dose of IV broad-spectrum antibiotic were included in this retrospective study. The presence of bacterial infection was determined using Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) definitions, microbiologic, radiographic, and laboratory findings. Suspected infections lacked microbiologic data. The primary outcome was the percentage of confirmed and suspected infections. Secondary outcomes included 90-day Clostridioides difficile infection (CDI) and 90-day drug-resistant organism (DRO) infections. Results A total of 218 patients were included. The percentages of confirmed/suspected and absence of bacterial infections were 63.8% and 36.2%, respectively. Elevated SIRS (≥ 2) and Quick Sequential Organ Failure Assessment (qSOFA; ≥ 2) scores were not associated with the presence of bacterial infections. 82% of patients were discharged from the ED. Antibiotic exposure in days of therapy in the ED and/or hospital admission did not significantly vary between patients with confirmed/suspected bacterial infection and those with absence of bacterial infections. Among patients who lacked evidence of bacterial infections, 44% were prescribed outpatient antibiotics after being discharged from the ED. 90-day CDI and DRO infections were identified in 7 and 6 patients, respectively, regardless of the presence of bacterial infections. Table 1. Baseline demographics of patients admitted to the ED with suspected sepsis Conclusion A third of the patients with suspected sepsis received IV broad-spectrum antibiotics in the ED but ultimately lacked bacterial infection. Our findings suggest that identification of bacterial infection and patients with sepsis using SIRS or qSOFA lack specificity and can lead to the overuse of unnecessary antibiotics in the ED. Disclosures All Authors: No reported disclosures

scholarly journals 1135. The Effect of Penicillin Allergy Labels on Antibiotic Prescribing for Children Diagnosed with Upper Respiratory Tract Infections in Two Primary Care Networks

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S658-S659
Author(s):  
Torsten Joerger ◽  
Margaret Taylor ◽  
Debra Palazzi ◽  
Jeffrey Gerber
Keyword(s):  
Broad Spectrum ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Upper Respiratory Tract Infections ◽  
Antibiotic Prescribing ◽  
Second Line ◽  
Upper Respiratory Tract ◽  
Broad Spectrum Antibiotic ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background In pediatric inpatient settings, unconfirmed penicillin allergy labels (PALs) are associated with increased broad-spectrum antibiotic use, costs, and adverse events. However, 90% of antibiotics are prescribed in the outpatient setting and 70% of these antibiotics are given for upper respiratory tract infections (URTI.) Little is known about the effect of PALs on antibiotic prescribing in the pediatric outpatient population. Methods A retrospective birth cohort was created of children born between January 1st 2010 and June 30th 2020 and seen at one of 91 Texas Children’s Pediatrics or Children’s Hospital of Philadelphia primary care clinics. Children with an ICD10 code for an URTI and an antibiotic prescription were stratified into those with or without a penicillin allergy label at the time of the infection. Rates of second-line and broad-spectrum antibiotic use were compared. Results The birth cohort included 334,465 children followed for 1.2 million person-years. An antibiotic was prescribed for 696,782 URTIs and the most common diagnosis was acute otitis media. Children with PALs were significantly more likely to receive second-line antibiotics (OR 35.0, 95% CI 33.9-36.1) and broad-spectrum antibiotics (OR 23.9, 95% CI 23.2-24.8.) Children with PALs received more third generation cephalosporins (60% vs. 15%) and more macrolide antibiotics (25% vs. 3%) than those without a PAL. Overall, 18,015 children (5.4%) acquired a PAL during the study period, which accounted for 23% of all second-line antibiotic prescriptions and 17% of all broad-spectrum antibiotic use for URTIs. Multivariable logistic regression for receipt of second-line antibiotics for upper respiratory tract infections Conclusion PALs are common and account for a substantial proportion of second-line and broad-spectrum antibiotic use in pediatric outpatients treated for URTIs. Efforts to de-label children with PALs are likely to increase first-line antibiotic use and decrease broad-spectrum antibiotic use for URTIs, the most common indication for antibiotic prescribing to children. Disclosures Debra Palazzi, MD, MEd, AAP (Other Financial or Material Support, PREP ID Editorial Board, PREP ID Course)AHRQ (Research Grant or Support)Elsevier (Other Financial or Material Support, Royalties for writing and editing chapters)JAMA Pediatrics (Board Member)

scholarly journals Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing

2020 ◽  
Author(s):  
Timothy M Rawson ◽  
Luke S P Moore ◽  
Nina Zhu ◽  
Nishanthy Ranganathan ◽  
Keira Skolimowska ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Web Of Science ◽  
Respiratory Infections ◽  
Secondary Analysis ◽  
Antibiotic Use ◽  
Rapid Review ◽  
Broad Spectrum Antibiotic ◽  
Antimicrobial Prescribing ◽  
Coronavirus Infection ◽  
Bacterial Coinfection

Abstract Background To explore and describe the current literature surrounding bacterial/fungal coinfection in patients with coronavirus infection. Methods MEDLINE, EMBASE, and Web of Science were searched using broad-based search criteria relating to coronavirus and bacterial coinfection. Articles presenting clinical data for patients with coronavirus infection (defined as SARS-1, MERS, SARS-CoV-2, and other coronavirus) and bacterial/fungal coinfection reported in English, Mandarin, or Italian were included. Data describing bacterial/fungal coinfections, treatments, and outcomes were extracted. Secondary analysis of studies reporting antimicrobial prescribing in SARS-CoV-2 even in absence of coinfection was performed. Results 1007 abstracts were identified. Eighteen full texts reporting bacterial/fungal coinfection were included. Most studies did not identify or report bacterial/fungal coinfection (85/140; 61%). Nine of 18 (50%) studies reported on COVID-19, 5/18 (28%) on SARS-1, 1/18 (6%) on MERS, and 3/18 (17%) on other coronaviruses. For COVID-19, 62/806 (8%) patients were reported as experiencing bacterial/fungal coinfection during hospital admission. Secondary analysis demonstrated wide use of broad-spectrum antibacterials, despite a paucity of evidence for bacterial coinfection. On secondary analysis, 1450/2010 (72%) of patients reported received antimicrobial therapy. No antimicrobial stewardship interventions were described. For non–COVID-19 cases, bacterial/fungal coinfection was reported in 89/815 (11%) of patients. Broad-spectrum antibiotic use was reported. Conclusions Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal coinfection. Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic is urgently required.

Sign in / Sign up

Export Citation Format

Share Document