scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

scholarly journals The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 113
Author(s):  
Tri Pudy Asmarawati ◽  
Alfian Nur Rosyid ◽  
Satriyo Dwi Suryantoro ◽  
Bagus Aulia Mahdi ◽  
Choirina Windradi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intensive Care Treatment ◽  
Care Treatment ◽  
Causative Agents

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a retrospective cohort study, among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.

scholarly journals The Prevalence of Multi-Drug Resistant Organisms and Their Outcomes in an ICU in Mauritius: An Observational Study

2020 ◽  
pp. 71-78
Author(s):  
Dooshanveer Chowbay Nuckchady ◽  
Samiihah Hafiz Boolaky
Keyword(s):  
Length Of Stay ◽  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Drug Resistant ◽  
Retrospective Case ◽  
Carbapenem Resistant

Aims: To assess the prevalence of multi-drug resistant organisms (MDRO) in an ICU of Mauritius and determine the relationship between antibiotic resistance and mortality as well as length of stay and duration of antibiotic use. Study Design: Retrospective case control study. Place and Duration of Study: This study examined the data of patients who were admitted from 2015 to 2016 at an ICU in Port Louis, Mauritius. Methodology: 128 patients on whom cultures were ordered were included. Adjustment was performed using multivariate Cox regression and negative binomial regression. Results: Out of 214 organisms that were isolated, 68% were an MDRO; 78% of Enterobacteriaceae were ESBL, 86% of Acinetobacter spp., 30% of Enterobacteriaceae and 80% of Pseudomonas spp. were carbapenem resistant while 53% of Staphylococcus aureus were MRSA. After adjustment, MDRO were linked to a non-statistically significant 13% increase in mortality (P = .056), a rise in hospital length of stay from 19 days to 29 days (P = .0013) and an escalation in duration of antibiotic use from 11 days to 24 days (P = 1.3E-10). Conclusion: Infections with MDRO are common in Mauritius and strategies should be put into place to reduce their prevalence.

scholarly journals Increased Length of Stay Associated With Antibiotic Use in Older Adults With Advanced Cancer Transitioned to Comfort Measures

2019 ◽  
Vol 37 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Rupak Datta ◽  
Mojun Zhu ◽  
Ling Han ◽  
Heather Allore ◽  
Vincent Quagliarello ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Regression Model ◽  
Advanced Cancer ◽  
Poisson Regression ◽  
Older Patients ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cancer Type ◽  
Poisson Regression Model

Background: Antibiotic use may increase hospital length of stay (LOS) among older patients with advanced cancer who are transitioned to comfort measures. Methods: We studied a cohort of patients with advanced cancer aged ≥65 years who were transitioned to comfort measures during admission from July 1, 2014, through November 30, 2016. We evaluated the association between antibiotic exposure and LOS using a Poisson regression model adjusted for age, gender, cancer type, comorbidities, infection, and intensive care unit admission. Results: Among 461 patients with advanced cancer, median age was 74 years (range: 65-99), 49.0% (n = 226) were female, and 20.6% (n = 95) had liquid tumors. Overall, 82.9% (n = 382) received ≥1 antibiotic and 64.6% (n = 298) had ≥1 infection diagnosis during hospitalization. Infection diagnoses commonly included sepsis (35%, n = 161/461), pneumonia (25%, n = 117/461), and urinary tract infection (14%, n = 66/461). Among those receiving antibiotics, the most common choices included vancomycin (79%, n = 300/382), cephalosporins (63%, n = 241/382), and penicillins (45%, n = 172/382). In a multivariable Poisson regression model, LOS was 34% longer (count ratio = 1.34, [95% confidence interval: 1.20-1.51]) among those exposed versus unexposed to antibiotics. Conclusions: Antibiotic use among patients with advanced cancer who are transitioned to comfort measures is associated with longer LOS. These data illustrate the importance of tradeoffs associated with antibiotic use, such as unintended increased LOS, when striving for goal-concordant care near the end of life.

scholarly journals Impact of Procalcitonin Guidance on the Management of Adults Hospitalized with Pneumonia

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S17-S17
Author(s):  
Thomas Walsh ◽  
Briana DiSilvio ◽  
Crystal Hammer ◽  
Moeezullah Beg ◽  
Swati Vishwanathan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Real World ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Teaching Hospitals ◽  
Post Intervention ◽  
Duration Of Therapy

Abstract Background Community-acquired pneumonia and healthcare-associated pneumonia are often treated with prolonged antibiotic therapy. Procalcitonin (PCT) has effectively and safely reduced antibiotic use for pneumonia in controlled studies. However, limited data exist regarding PCT guidance in real-world settings for management of pneumonia. Methods A retrospective, preintervention/postintervention quality improvement study was conducted to compare management for patients admitted with pneumonia before and after implementation of PCT guidance at two teaching hospitals in Pittsburgh, Pennsylvania. The preintervention period was March 1, 2014 through October 31, 2014, and the post-intervention period was March, 1 2015 through October 31, 2015. Results A total of 152 and 232 patients were included in the preintervention and postintervention cohorts, respectively. When compared with the preintervention group, the mean duration of therapy decreased (9.9 vs. 6.1 days; P &lt; 0.001). More patients received an appropriate duration of 7 days or less (26.9% vs. 66.4%; P &lt; 0.001). Additionally, mean hospital length of stay decreased in the postintervention group (4.9 vs. 3.5 days; P = 0.006). Pneumonia-related 30-day readmission rates (7.2% vs. 4.3%; P = 0.99) were unaffected. In the postintervention group, patients with PCT levels &lt; 0.25 µg/l received shorter mean duration of therapy compared with patients with levels &gt;0.25 µg/l (8.0 vs. 4.6 days; P &lt; 0.001) as well as reduced hospital length of stay (3.9 vs. 3.2 days; P = 0.02). Conclusion In this real-world practice study, PCT guidance led to shorter durations of total antibiotic therapy and abridged inpatient length of stay without affecting hospital re-admissions. Disclosures All authors: No reported disclosures.

scholarly journals 191. Oral Antibiotic Step-Down Therapy for Non-Staphylococcal Gram-Positive Bloodstream Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S203-S203
Author(s):  
Kelvin Gandhi ◽  
Magdalena Wrzesinski ◽  
Kristen Bunnell ◽  
Ashley Long ◽  
Vanessa Hutzley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Bloodstream Infections ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bivariate Analysis ◽  
Oral Antibiotic ◽  
Clinical Failure ◽  
Oral Group ◽  
Step Down ◽  
Primary Composite Outcome

Abstract Background Bloodstream infections are traditionally treated with intravenous (IV) antimicrobial therapy, which may increase length of stay and healthcare costs. The purpose of this study is to evaluate if oral antibiotic step-down therapy for non-staphylococcal gram-positive bloodstream infections (GP-BSIs) is non-inferior to IV antibiotics. Methods This single-center, retrospective cohort study included patients with a non-Staphylococcus aureus, non-Staphylococcus lugdunensis GP-BSI from January 2017 to December 2019. Patients were excluded if they fit any of the following criteria: organism identified as contaminant, polymicrobial BSI, recurrent BSI within the past 90 days, or receipt of an effective antibiotic for a duration longer than what is indicated for BSI treatment. Patients were categorized into those who received an IV antibiotic for the total duration of therapy and those who received an oral step-down antibiotic for at least one-third of the treatment course. The primary composite outcome was the incidence of 90-day clinical failure consisting of 90-day all-cause mortality, change in therapy due to inadequate clinical response, and 90-day BSI recurrence. The secondary outcomes included the individual components of the primary composite outcome, line-related complications, and hospital length of stay. Bivariate analysis was conducted to assess for predictors of 90-day clinical failure. Results A total of 308 patients were included (oral group, n=94; IV group, n=214). Pitt Bacteremia Scores were low overall, but higher in the IV group (0 vs 1, p=0.045). The oral group had a higher proportion of GP-BSI caused by streptococcal species (76% vs 61%, p&lt; 0.001). The oral group had a lower incidence of 90-day clinical failure and was found to be noninferior to the IV group (9% vs 14%; mean difference -5%, 90% CI -12.7 to 2.6). The IV group had a longer hospital length of stay (4 vs 6 days, p&lt; 0.001), however there were no other significant differences in secondary outcomes. Bivariate analysis found no significant predictors of 90-day clinical failure. Conclusion Oral antibiotic step-down therapy was found to be non-inferior to IV antibiotic therapy, and thus may be an alternative option for the treatment of non-staphylococcal GP-BSIs. Disclosures All Authors: No reported disclosures

Is Acute Appendicitis a Surgical Emergency?

2007 ◽  
Vol 73 (6) ◽  
pp. 626-629 ◽  
Author(s):  
Kurt Stahlfeld ◽  
John Hower ◽  
Sarah Homitsky ◽  
Jeffrey Madden
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Negative Impact ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Group A

Urgent appendectomy has become the basis of management for acute appendicitis because of the disparity in morbidity and mortality rates between perforated and nonperforated appendicitis. Immediate surgery results in the confirmation of diagnosis and the control of sepsis without the risk of recurrent appendicitis. However, when notified by the emergency room of the diagnosis, many surgeons are opting to begin antibiotics and intravenous fluids and to schedule the appendectomy at their convenience. We hypothesize that using intravenous antibiotics and hydration to delay appendectomy until “normal business hours” has a negative impact on patient morbidity and mortality. During a 23-month period, the medical records of 81 patients at a single institution who underwent appendectomy were reviewed. All patients had preoperative CT scans and all operations were performed by one of two surgeons. Group A included those patients who underwent appendectomy within 10 hours of CT diagnosis and group B included those appendectomies performed greater than 10 hours after diagnosis. Wound complications, antibiotic use, total analgesic requirements, length of operation, and hospital length of stay were used for comparison. The average time to operation (3.18 vs 15.85 hours), operative time (54.1 vs 55.7 minutes), length of stay (2.65 vs 2.09 days), wound infections (4 vs 0), and antibiotic use at discharge (19 vs 3) for group A and B were not statistically different. This data suggests that delaying operative intervention for acute appendicitis to accommodate a surgeon's preference or to maximize a hospital's efficiency does not pose a significant risk to the patient.

scholarly journals The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 113
Author(s):  
Tri Pudy Asmarawati ◽  
Alfian Nur Rosyid ◽  
Satriyo Dwi Suryantoro ◽  
Bagus Aulia Mahdi ◽  
Choirina Windradi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intensive Care Treatment ◽  
Cross Sectional ◽  
Care Treatment

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a cross sectional study with retrospective approach, among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.

scholarly journals 182. Missed Opportunities to Discontinue Unnecessary Vancomycin During Pharmacist Therapeutic Monitoring

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Corey J Medler ◽  
Mary Whitney ◽  
Juan Galvan-Cruz ◽  
Ron Kendall ◽  
Rachel Kenney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Drug Events ◽  
Academic Medical Center ◽  
Total Duration ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Monitoring ◽  
Resistant Bacteria ◽  
Therapeutic Drug ◽  
Missed Opportunities

Abstract Background Unnecessary and prolonged IV vancomycin exposure increases risk of adverse drug events, notably nephrotoxicity, which may result in prolonged hospital length of stay. The purpose of this study is to identify areas of improvement in antimicrobial stewardship for vancomycin appropriateness by clinical pharmacists at the time of therapeutic drug monitoring (TDM). Methods Retrospective, observational cohort study at an academic medical center and a community hospital. Inclusion: patient over 18 years, received at least three days of IV vancomycin where the clinical pharmacy TDM service assessed for appropriate continuation for hospital admission between June 19, 2019 and June 30, 2019. Exclusion: vancomycin prophylaxis or administered by routes other than IV. Primary outcome was to determine the frequency and clinical components of inappropriate vancomycin continuation at the time of TDM. Inappropriate vancomycin continuation was defined as cultures positive for methicillin-susceptible Staphylococcus aureus (MRSA), vancomycin-resistant bacteria, and non-purulent skin and soft tissue infection (SSTI) in the absence of vasopressors. Data was reported using descriptive statistics and measures of central tendency. Results 167 patients met inclusion criteria with 38.3% from the ICU. SSTIs were most common indication 39 (23.4%) cases, followed by pneumonia and blood with 34 (20.4%) cases each. At time of vancomycin TDM assessment, vancomycin continuation was appropriate 59.3% of the time. Mean of 4.22 ± 2.69 days of appropriate vancomycin use, 2.18 ± 2.47 days of inappropriate use, and total duration 5.42 ± 2.94. 16.4% patients developed an AKI. Majority of missed opportunities were attributed to non-purulent SSTI (28.2%) and missed MRSA nares swabs in 21% pneumonia cases (table 1). Conclusion Vancomycin is used extensively for empiric treatment of presumed infections. Appropriate de-escalation of vancomycin therapy is important to decrease the incidence of adverse effects, decreasing hospital length of stay, and reduce development of resistance. According to the mean duration of inappropriate therapy, there are opportunities for pharmacy and antibiotic stewardship involvement at the time of TDM to optimize patient care (table 1). Missed opportunities for vancomycin de-escalation Disclosures All Authors: No reported disclosures

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