scholarly journals 1050. Oral Antibiotics for the Treatment of Gram-Negative Bloodstream Infections: Prescribing Practices and Outcomes at a Large Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S313-S314
Author(s):  
Kimberly Claeys ◽  
Nora Loughry ◽  
Sanjay Chainani ◽  
Surbhi Leekha ◽  
Emily Heil
Keyword(s):  
Antibiotic Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Optimal Time ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
Gram Negative ◽  
Academic Medical

Abstract Background There is limited data to guide the use of oral (PO) antibiotics for the treatment of Gram-negative (GN) bloodstream infection (BSI). The objective of this study was to describe the characteristics and outcomes at a large academic medical center. Methods Retrospective observational cohort of adult patients (age ≥18 years) with at least one blood culture positive for aerobic Gram-negative organism(s) treated with antibiotic therapy (IV or oral [PO]) at University of Medical Center from November 2015 to May 2017. Oral antibiotics were described based on bioavailability. The primary outcome of interest was 30-day infection-related readmission. Secondary objectives included evaluation of patient characteristics associated with PO antibiotic use. Results During the defined study period 310 patients met inclusion; 113 (36.5%) were switched to PO antibiotic therapy for the treatment of GN BSI within a median of 5 (IQR 3–11) days. Oral antibiotics were initiated at discharge for 50 (44%) of patients switched. Patients switched to PO were less likely to have has a stay in the ICU (24.8% vs. 47.7%, P < 0.0001) and were less likely to have an ID consult (57.5% vs. 71.1%, P = 0.034). There was no difference in median Charlson Comorbidity Score (2, IQR 0–4). The most common sources of infection among those switched to PO agents were urinary (50, 44.2%) and intra-abdominal (25, 22.1%). The majority of patients were placed on a PO agent with high bioavailability (61, 54%), which included levofloxacin and moxifloxacin. There was a slightly higher proportion of use of high (vs. low) bioavailable antibiotics in patients with ID consult compared with those without (59% vs. 41%, P = 0.053). PO antibiotics were more frequently prescribed for patients discharged home (78, 69%) compared with patients discharged to Rehab/Short-term facility (28, 24.8%). Thirty-day hospital readmission was more common among the patients treated with PO antibiotics (18.6 vs. 8.1%, P = 0.006); however, ID-related readmission was rare (0.9% vs. 1%, P = 0.91). Conclusion Urinary and intra-abdominal sources and home discharge were common among those with PO antibiotic use. ID-related outcomes were similar among those treated with IV vs. PO agents. More research is necessary to determine optimal time to PO antibiotic switch. Disclosures K. Claeys, Nabriva: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. E. Heil, ALK-Abelló: Grant Investigator, Research grant.

scholarly journals Low Sensitivity of Procalcitonin for Bacteremia at an Academic Medical Center: A Cautionary Tale for Antimicrobial Stewardship

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Kellie J Goodlet ◽  
Emily A Cameron ◽  
Michael D Nailor
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Cautionary Tale ◽  
Academic Medical ◽  
Low Sensitivity ◽  
Klebsiella Spp ◽  
Rule Out

Abstract Background Procalcitonin testing has been adopted by antimicrobial stewardship programs as a means of reducing inappropriate antibiotic use, including within intensive care units (ICUs). However, concerns regarding procalcitonin’s sensitivity exist. The purpose of this study is to calculate the sensitivity of procalcitonin for bacteremia among hospitalized patients. Methods This was a retrospective cohort study of adult patients admitted to an academic medical center between July 1, 2018, and June 30, 2019, with ≥1 positive blood culture within 24 hours of admission and procalcitonin testing within 48 hours. Low procalcitonin was defined as <0.5 µg/L. Results A total of 332 patients were included. The sensitivity of procalcitonin for bacteremia was 62% at the sepsis threshold of 0.5 µg/L, 76% at a threshold of 0.25 µg/L, and 92% at a threshold of 0.1 µg/L. Of the 125 patients with low procalcitonin, 14% were initially admitted to the ICU and 9% required the use of vasopressors. In that same group, the top 3 organisms isolated were Staphylococcus aureus (39%), Escherichia coli (17%), and Klebsiella spp. (7%). Compared with those patients with elevated procalcitonin, patients with low procalcitonin were significantly more likely to have >24-hour delayed receipt of antibiotic therapy (3% vs 8%; P = .04), including among patients admitted to the ICU (1% vs 18%; P = .02). Conclusions The sensitivity of procalcitonin for bacteremia is unacceptably low for a rule-out test. Antimicrobial stewardship programs should use caution before promoting the withholding of antibiotic therapy for patients with low initial procalcitonin values.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

Adequacy of empiric gram-negative coverage for septic patients at an academic medical center

2019 ◽  
Vol 47 (10) ◽  
pp. 1194-1199 ◽  
Author(s):  
DaleMarie Vaughan ◽  
Amy Pakyz ◽  
Michael Stevens ◽  
Kimberly Lee ◽  
Shaina Bernard
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Gram Negative ◽  
Academic Medical

Pseudo-Outbreak ofMycobacterium chelonaeandMethtlobactertum mesophilicumCaused by Contamination of an Automated Endoscopy Washer

2001 ◽  
Vol 22 (7) ◽  
pp. 414-418 ◽  
Author(s):  
Amy Beth Kressel ◽  
Francine Kidd
Keyword(s):  
Dna Fingerprinting ◽  
Medical Center ◽  
Academic Medical Center ◽  
Gram Negative Bacteria ◽  
Source Water ◽  
Mycobacterium Chelonae ◽  
Gram Negative ◽  
Academic Medical ◽  
Control Department ◽  
Cleaning Cycle

AbstractObjective:To evaluate an unusual number of rapidly growing acid-fast bacilli, later identified asMycobacterium chelonae,and pink bacteria, later identified asMethylo-bacterium mesophilicum,from fungal cultures obtained by bronchoscopy.Design:Outbreak investigation.Setting:An academic medical center performing approximately 500 bronchoscopies and 4,000 gastrointestinal endoscopies in 1998.Patients:Patients undergoing bronchoscopy July 21 to October 2, 1998.Methods:The infection control department reviewed patient charts and bronchoscopy logs; obtained cultures of source water, faucets, washers, unopened glutaraldehyde, glutaraldehyde from the washers, and endoscopes; observed endoscope and bronchoscope cleaning and disinfecting procedures; reviewed glutaraldehyde monitoring records; and sentM chelonaeisolates for DNA fingerprinting.Results:M chelonae, M mesophilicum,gram-negative bacteria, and various molds grew from endoscopes, automated washers, and glutaraldehyde from the washers but not from unopened glutaraldehyde. The endoscopy unit regularly monitored the pH of glutaraldehyde, and the logs contained no deficiencies. The above sources remained positive for the same organisms after a glutaraldehyde cleaning cycle of the automated washers. DNA fingerprinting of theM chelonaerevealed that they were clonally related.Conclusions:The automated washers were contaminated with a biofilm that rendered them resistant to decontamination. The washers then contaminated the endoscopes and bronchoscopes they were used to disinfect. Our institution purchased new endoscopes and a new paracetic acid sterilization system.

scholarly journals Clinical Impact of Rapid Molecular Diagnosis of Bloodstream Infections at an Academic Medical Center in New York City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Matthew S. Simon ◽  
Angela Loo ◽  
Michael Satlin ◽  
Harjot Singh ◽  
Christina Chai ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Molecular Diagnosis ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Clinical Impact ◽  
Academic Medical

A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center

CHEST Journal ◽  
2017 ◽  
Vol 151 (5) ◽  
pp. 1011-1017 ◽  
Author(s):  
Anna M. Civitarese ◽  
Eric Ruggieri ◽  
J. Matthias Walz ◽  
Deborah Ann Mack ◽  
Stephen O. Heard ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Total Hospital ◽  
Academic Medical

scholarly journals Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience

2018 ◽  
Vol 39 (12) ◽  
pp. 1419-1424 ◽  
Author(s):  
Rachael A. Lee ◽  
Morgan C. Scully ◽  
Bernard C. Camins ◽  
Russell L. Griffin ◽  
Danielle F. Kunz ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Rate Of Change ◽  
Gram Negative ◽  
E Coli ◽  
Stewardship Program ◽  
Restriction Policy ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Gram Negative Organisms

AbstractObjectiveDue to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.DesignRetrospective cohort.SettingLarge academic medical center.MethodsWe performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).ResultsLarge rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).ConclusionsA stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.

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