scholarly journals 1136. Antifungal Prescribing Patterns among Hospitalized Children in the United States: Are There Opportunities for Antifungal Stewardship?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S404-S404
Author(s):  
Lourdes Eguiguren ◽  
Laura Bio ◽  
Brian R Lee ◽  
Jason Newland ◽  
Adam Hersh ◽  
...  
Keyword(s):  
Combination Therapy ◽  
The United States ◽  
Marrow Transplant ◽  
Antifungal Prophylaxis ◽  
Prescribing Patterns ◽  
Receive Combination Therapy ◽  
Hospitalized Children ◽  
Antifungal Stewardship ◽  
Prevalence Survey ◽  
Antifungal Use

Abstract Background Antifungal stewardship may help reduce the toxicity, cost, and emergence of resistance related to inappropriate antifungal use. A better understanding of antifungal prescribing patterns, particularly in high-risk, high-utilization populations, is needed to guide appropriate stewardship interventions. We analyzed antifungal prescribing characteristics, including the indications for use and differences between oncology/bone marrow transplant (Onc/BMT) and non-Onc/BMT patients, using a multi-center national cohort of hospitalized children. Methods We analyzed antifungal prescribing data from 32 hospitals that participated in the SHARPS Antibiotic Resistance, Prescribing, and Efficacy among Children (SHARPEC) study, a point prevalence survey conducted quarterly between June 2016 and December 2017. We included inpatients <18 years of age with an active order for a systemic antifungal agent and evaluated the patient and antifungal characteristics. In the Onc/BMT group, we classified antifungal prescribing by indication and compared the proportion of antifungal prescriptions in each category based on antifungal class, route of administration, and use of combination therapy. Results Six percent (2,095/34,927) of patients received a total of 2,207 antifungal prescriptions. Fifty-eight percent (1,291/2,207) of antifungal prescriptions were for Onc/BMT patients. Among patients prescribed an antifungal, those with an Onc/BMT diagnosis were older, received broader-spectrum agents, and were more likely to receive combination therapy (Table 1). The majority of antifungal use in the Onc/BMT group was for prophylaxis, with significant variation in the rate and choice of prophylactic antifungal prescribing across hospitals (Figure 1). Combination antifungal use was common among Onc/BMT patients receiving targeted therapy (Table 2). Conclusion The majority of antifungal use among hospitalized children is for patients with an Onc/BMT diagnosis and the patterns of antifungal utilization in this population appear to differ significantly from non-Onc/BMT patients. Based on the variation observed in this nationwide cohort, potential stewardship targets include the rate and type of antifungal prophylaxis and the use of combination therapy in Onc/BMT patients. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Use Among Hospitalized Children and Neonates in China: Results From Quarterly Point Prevalence Surveys in 2019

2021 ◽  
Vol 12 ◽  
Author(s):  
Chu-ning Wang ◽  
Jianning Tong ◽  
Bin Yi ◽  
Benedikt D. Huttner ◽  
Yibing Cheng ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Antibiotic Use ◽  
Point Prevalence ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Prevalence Survey ◽  
Common Diagnosis ◽  
Tract Infections ◽  
The Impact

Background: Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions.Methods: We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children’s hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification.Results: A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% (n = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, n = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions (n = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, n = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, n = 2,962), macrolides (12.1%, n = 2,214) and carbapenems (7.7%, n = 1,331).Conclusion: Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.

scholarly journals Outpatient antifungal prescribing patterns in the United States, 2018

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Kaitlin Benedict ◽  
Sharon V. Tsay ◽  
Monina G. Bartoces ◽  
Snigdha Vallabhaneni ◽  
Brendan R. Jackson ◽  
...  
Keyword(s):  
United States ◽  
Nurse Practitioners ◽  
The United States ◽  
Antifungal Drugs ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
The South ◽  
Antifungal Stewardship ◽  
Prescription Rates

Abstract Background: Widespread inappropriate antibiotic prescribing is a major driver of resistance. Little is known about antifungal prescribing practices in the United States, which is concerning given emerging resistance in fungi, particularly to azole antifungal agents. Objective: We analyzed outpatient antifungal prescribing data in the United States to inform stewardship efforts. Design: Descriptive analysis of outpatient antifungal prescriptions dispensed during 2018 in the IQVIA Xponent database. Methods: Prescriptions were summarized by drug, sex, age, geography, and healthcare provider specialty. Census denominators were used to calculate prescribing rates among demographic groups. Results: Healthcare providers prescribed 22.4 million antifungal courses in 2018 (68 prescriptions per 1,000 persons). Fluconazole was the most commonly prescribed drug (75%), followed by terbinafine (11%) and nystatin (10%). Prescription rates were higher among females versus males (110 vs 25 per 1,000 population) and adults versus children (82 vs 27 per 1,000 population). Prescription rates were highest in the South (81 per 1,000 population) and lowest in the West (48 per 1,000 population). Nurse practitioners and family practitioners prescribed the most antifungals (43% of all prescriptions), but the highest prescribing rates were among obstetrician-gynecologists (84 per provider). Conclusions: Prescribing antifungal drugs in the outpatient setting is common, with enough courses dispensed for 1 in every 15 US residents in 2018. Fluconazole use patterns suggest vulvovaginal candidiasis as a common indication. Regional prescribing differences could reflect inappropriate use or variations in disease burden. Further study of higher antifungal use in the South could help target antifungal stewardship practices.

Pulmonary fungal infections in acute leukemias and aggressive lymphomas: Analysis of the United States National Inpatient Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19042-e19042
Author(s):  
Oluwatobi Ozoya ◽  
Adaeze Ayuk ◽  
Odunayo Lawal ◽  
Josephine Emole
Keyword(s):  
Native American ◽  
High Risk ◽  
Fungal Infections ◽  
The United States ◽  
Marrow Transplant ◽  
Antifungal Prophylaxis ◽  
Therapeutic Drug ◽  
Acute Leukemias ◽  
Aggressive Lymphomas ◽  
Pulmonary Fungal Infections

e19042 Background: For patients undergoing intensive chemotherapy, pulmonary fungal infections (PFI) represent a major cause of morbidity and mortality. Our study examined predictors and outcomes of PFI in hospitalized patients (pts) with hematological malignancies in the current era of antifungal prophylaxis for high-risk patients. Methods: Using the 2018 National Inpatient Sample (NIS) database, we conducted a retrospective study of hospitalized pts aged ≥ 18 years, with acute leukemias or aggressive lymphomas. Hospitalizations were selected using International Classification of Disease, Tenth Revision (ICD-10) codes for leukemias, lymphomas and PFI (candidiasis, aspergillosis, cryptococcus, and mucormycosis). Demographics, comorbidities, and outcomes were compared between pts with and without PFI using Chi-squared test. Multivariable logistic regression was performed to explore predictors associated with PFI. Results: Of 205,525 hospitalizations that met the inclusion criteria, PFI was diagnosed in 1635 (0.8%). Frequent infections were aspergillosis (80%) and candidiasis (11%). Pts with acute myeloid leukemia (AML) accounted for 64% of all PFI. The PFI group, compared to non-PFI, were more likely to be non-Caucasian (39% vs 32%, p<0.05), have higher Charlson comorbidity index (CI) [64% vs 55%, p<0.01], longer mean length of stay (23 vs 9 days, p<0.001), and more likely to have AML (64% vs 33%, p<0.001). Pts with PFI had higher odds of acute respiratory failure, severe sepsis, and in-hospital mortality. Mortality rates for PFI and non-PFI group were 17% and 6% respectively (p<0.001). Predictors associated with PFI were Hispanic or Native American race, Charlson CI ≥ 3, neutropenia, malnutrition, bone marrow transplant status and diagnosis of AML (Table). Conclusions: Our study identified clinical variables that predicted for PFI in patients with acute leukemias and aggressive lymphomas. Pts with these high-risk characteristics should get priority for close surveillance, mold-specific prophylaxis, and antifungal therapeutic drug monitoring. Selected predictors associated with pulmonary fungal infections. Adjusted Odds ratio (OR).[Table: see text]

Quality of inpatient antimicrobial use in hematology and oncology patients

2021 ◽  
pp. 1-10
Author(s):  
Abby P. Douglas ◽  
Lisa Hall ◽  
Rodney S. James ◽  
Leon J. Worth ◽  
Monica A. Slavin ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Antifungal Prophylaxis ◽  
Neutropenic Fever ◽  
Antibacterial Prophylaxis ◽  
Separate Analysis ◽  
Prescribing Practices ◽  
Oncology Patients ◽  
Antimicrobial Prescribing ◽  
Using Data ◽  
To Receive

Abstract Objectives: To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. Design: Retrospective comparative analysis of a national prospectively collected database. Methods: Using data from the 2014–2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. Results: In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%–90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3–13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9–5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). Conclusions: This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.

scholarly journals POS0176 COMBINING CXCL5 WITH CONVENTIONAL THERAPY PROVIDES DURABLE IMMUNOSUPPRESSION IN MURINE LUPUS NEPHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 301.1-301
Author(s):  
X. Fan ◽  
D. Guo ◽  
F. Lim ◽  
J. Thumboo ◽  
W. Hwang ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Combination Therapy ◽  
Graft Versus Host Disease ◽  
Conventional Therapy ◽  
Immune Cell ◽  
Marrow Transplant ◽  
High Concentration ◽  
Host Disease ◽  
Graft Versus Host ◽  
Luminex Technology

Background:Lupus nephritis (LN) is a condition arising from abnormal immune responses to internal organs. Patients with LN suffer from severe morbidity and mortality1, 2. Despite the aggressive regimen, 20-40% of patients do not respond to current conventional therapy. CXCL5, as a potent chemoattractant and activator of neutrophils3, demonstrates strong immunosuppression in the pre-clinical mouse model of graft versus host disease (GvHD)4 and lupus nephritis (LN) by intravenous administration.Objectives:In this study, we aim to evaluate whether the therapeutic effect of conventional therapy could be further improved by combination therapy with CXCL5.Methods:Ten doses of exogenous CXCL5 (3ug/kg, biweekly) together with conventional therapy (methylprednisolone (MP, intravenous (IV) injection with 8.3mg/kg/day at day-1, day-2 and day-3) + cyclophosphamide (CP, IV injection with 0.5g/BSA at day-4, monthly for 5 doses)) were administered to 8-week-old Faslpr mice by IV injection. Mice were monitored for 64 weeks. Splenic immune profile at 3 weeks post treatment (PT) was measured by flow cytometry. Circulating cytokine profile were detected by Luminex technology. Renal function was evaluated by urinary spot albumin creatinine ratio. In situ renal immune cell infiltration and complement 3 deposition were detected by Haematoxylin and Eosin (H&E) and immunohistochemistry staining.Results:Comparing to control mice (dPBS: 0% at 28 weeks PT), mice survival was improved to 100% at 40 weeks PT and 55.6% at 64 weeks PT by combination therapy of CXCL5 and conventional therapy (MP + CP) (p<0.0001). The accumulation of autoantibody (anti-dsDNA) and proteinuria were reduced 61.2-fold at 32 weeks PT (p=0.004) and 83.5-fold at 28 weeks PT (p=0.03) respectively. Both autoantibody and proteinuria were maintained at low level for 64 weeks. The classification of LN was significantly reduced at 10 weeks PT and equivalent to the classes we observed in pre-onset mice (p=0.004). Although combination therapy was not able to promote Tregs, it reduced both innate (neutrophils and macrophages) and adaptive (TH1, TH2 and TH17 cells and B cells) immunities significantly. Concomitantly, the serum level of endogenous CXCL5 was boosted up by exogenous administration from 74.2 +/- 53.9 pg/ml to 254.1 +/- 147.1 pg/ml at 8 weeks PT (p=0.05) and this relative high concentration was maintained for 48 weeks.Conclusion:Combining CXCL5 with conventional therapy provides effective and durable immunosuppression in murine LN and it may provide a new option for LN therapy.References:[1]Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. May 8 2017;12(5):825-835. doi:10.2215/cjn.05780616.[2]Touma Z, Gladman DD. Current and future therapies for SLE: obstacles and recommendations for the development of novel treatments. Lupus Sci Med. 2017;4(1):e000239. doi:10.1136/lupus-2017-000239.[3]Koltsova EK, Ley K. The mysterious ways of the chemokine CXCL5. Immunity. Jul 23 2010;33(1):7-9. doi:10.1016/j.immuni.2010.07.012.[4]Fan X, Guo D, Cheung AMS, et al. Mesenchymal Stromal Cell (MSC)-Derived Combination of CXCL5 and Anti-CCL24 Is Synergistic and Superior to MSC and Cyclosporine for the Treatment of Graft-versus-Host Disease. Biol Blood Marrow Transplant. Jun 5 2018;doi:10.1016/j.bbmt.2018.05.029.Disclosure of Interests:None declared

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

2016 ◽  
Vol 6 (7) ◽  
pp. 404-411 ◽  
Author(s):  
Daniel J. Adams ◽  
Matthew D. Eberly ◽  
Anthony Goudie ◽  
Cade M. Nylund
Keyword(s):  
United States ◽  
The United States ◽  
Hospitalized Children ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Resistant

scholarly journals 1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S720-S720
Author(s):  
Amy M Beeson ◽  
Grace E Marx ◽  
Amy M Schwartz ◽  
Alison F Hinckley
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Standard Treatment ◽  
Age Distribution ◽  
Public Health Problem ◽  
The United States ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p&lt; 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p&lt; 0.0001) and during non-summer months (OR 2.2, p&lt; 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Candida parapsilosis Candidemia Resistance Patterns and Treatment Outcomes: An Opportunity for Antifungal Stewardship

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S86-S86
Author(s):  
Gary Fong ◽  
Kim Ngo ◽  
Hannah Russo ◽  
Nicholas Beyda
Keyword(s):  
Combination Therapy ◽  
Treatment Outcomes ◽  
Candida Parapsilosis ◽  
Medical Center ◽  
Antifungal Susceptibility ◽  
Antifungal Stewardship ◽  
Resistance Patterns ◽  
Fluconazole Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Candida parapsilosis has emerged as an important fungal pathogen with mortality rates up to 30%. Recent studies show no difference in treatment outcomes for patients treated both empirically and definitively with either echinocandins or fluconazole. However, the impact of antifungal susceptibility testing and opportunities for antifungal stewardship are less clear in this patient population. The purpose of this study was to assess antifungal susceptibility rates, treatment patterns, and outcomes among patients with C. parapsilosis candidemia. Methods This was a single-center, retrospective cohort review of adult patients with a positive blood culture for C. parapsilosis hospitalized at Baylor St. Luke’s Medical Center, between 2006 and 2016. Patients with mixed or breakthrough candidemia were excluded as well as patients who expired within 3 days of candidemia onset. Results Eighty patients with C. parapsilosis candidemia were identified of which 48 met inclusion criteria. Nine patients had infections caused by fluconazole non-susceptible isolates (19%). The most common empiric treatment choice was an echinocandin (33/48, 69%), followed by fluconazole (9/48, 19%), and combination therapy (6/48, 13%). Of the 39 patients with fluconazole susceptible isolates, only 17 were treated with fluconazole definitively (44%). Among patients who received empiric echinocandin vs. fluconazole therapy, there was no difference in 14-day mortality (9% vs. 11%, P = 1.00) or in-hospital mortality (12% vs. 11%, P = 1.00). Empiric combination therapy was the only independent risk factor for treatment failure (OR, 13.8; 95% CI, 1.4–138.3; P = 0.03). Conclusion Treatment outcomes for patients receiving echinocandins were similar for those receiving fluconazole. At our institution, the increased incidence of fluconazole non-susceptible isolates warrants the use of echinocandins empirically. Patients were more likely to remain on echinocandin therapy even when fluconazole susceptible isolates were identified. This study reinforces the guideline suggestion that neither echinocandins nor fluconazole treatment leads to superior outcomes, but also identifies a cohort of patients in need of antifungal stewardship. Disclosures N. Beyda, Astellas: Grant Investigator and Scientific Advisor, Research grant

scholarly journals Determination of combination therapy prescribing patterns for the treatment of acute agitation in psychiatric patients: A regression model of patient diagnoses and demographics

2019 ◽  
Vol 9 (5) ◽  
pp. 298-303
Author(s):  
Mark S. Maas ◽  
Karen E. Moeller ◽  
Brittany L. Melton
Keyword(s):  
Combination Therapy ◽  
Regression Model ◽  
Psychiatric Patients ◽  
A Priori ◽  
Young Male ◽  
Binary Logistic Regression ◽  
Prescribing Patterns ◽  
Cardiovascular Comorbidity ◽  
Logistic Regression Models ◽  
Acute Agitation

Abstract Introduction Guidelines for the treatment of acute agitation typically recommend monotherapy with an antipsychotic or a benzodiazepine, but combination therapy is frequently used in practice. We created a regression model to identify which factors lead to the prescribing of combination therapy for acute agitation on a psychiatry unit. Methods We collected retrospective data from hospitalized patients in the psychiatry unit. An a priori alpha of 0.05 was used for binary logistic regression models to determine if and how the number of prescribed medications for acute agitation was influenced by: age, sex, race, cardiovascular comorbidities, and psychiatric diagnoses. Results We identified 1998 encounters from 1200 patients. Patients are significantly more likely to be prescribed combination therapy if they are young, male, and of non-white race or have a diagnosis of central nervous system stimulant use, hallucinogen use, depression, bipolar, cluster B personality, or psychosis. Patients are significantly more likely to be prescribed monotherapy if they have cardiovascular comorbidity or have neurocognitive disorder. Discussion Several demographic or diagnostic factors predict combination therapy prescribing. Acute agitation guidelines should be reviewed to include more clear instructions on combination therapy use.

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