Stewardship / Resistance Scan for Aug 16, 2021
Antibiotic stewardship in hospitalized seniors tied to better outcomes
An analysis of hospitalized geriatric patients found that rigorous de-escalation and curtailing of antibiotics was associated with reductions in hospital readmission and mortality, US researchers reported last week in JAC-Antimicrobial Resistance.
In the study, researchers compared a cohort of patients ages 65 and older at a 256-bed teaching hospital who received antibiotic stewardship program (ASP) interventions from January through June 2017 with a control group of patients in the same age-group at the same hospital who had received antibiotics before the intervention (January through June 2015).
The ASP included de-escalation of empiric or definitive antibiotic therapy, change in duration of therapy, and discontinuation of therapy. The stewardship team met daily to discuss and convey recommendations. Patients included in the study had diagnoses of pneumonia (PNA), urinary tract infection, acute bacterial skin and skin-structure infection (ABSSSI), and complicated intra-abdominal infection.
Overall, there was more than 95% adherence to stewardship recommendations, the majority of which were de-escalations (64%) and discontinuations (24%) and resulted in a significant decrease of broad-spectrum antibiotic use.
Analysis of outcomes showed that the 30-day hospital readmission rate fell from 24.9% in the control group to 9% in the ASP group, with the biggest declines observed among patients diagnosed with PNA and ABSSSI. The rate of 30-day readmission for Clostridioides difficile infection fell from 2.4% to 0.30%. Mortality fell from 9.6% in the control group to 5.4% post-intervention.
In addition, antibiotic expenditures fell from $23.30 per adjusted patient day to $4.30 following implementation of the ASP.
“Studying the association between ASP efforts and patient outcomes is of great importance as it increases our understanding of how ASPs contribute to the patient’s overall quality of care,” the authors wrote. “We show that a stringent ASP can be safely implemented in an elderly hospitalized patient population without discernible adverse outcomes.”
Aug 12 JAC-Antimicrob Resist study
Survey finds stewardship lagging in French nursing homes
A survey of French nursing homes shows there is large room for improvement in antibiotic stewardship, researchers reported yesterday in JAC-Antimicrobial Resistance.
Of the 417 nursing homes in the Grand Est region of northeastern France invited to participate in the survey, only 75 (18%) responded. The survey included 35 questions covering four topics: Nursing home characteristics, current antibiotic stewardship practices, attitudes toward antibiotic stewardship, and opinions on strategies to promote stewardship.
Core elements of antibiotic stewardship programs were overall present in fewer than half of the participating nursing homes, but only 3% did not have any stewardship activities in place. No specific nursing home characteristic was associated with the level of implementation of stewardship activities.
The three most implemented stewardship activities were antibiotic consumption monitoring (65%), antibiotic plan documentation (56%), and antibiotic prescription guide distribution (54%). Only 13% performed audit and feedback on antibiotic prescribing, and only 23% and 29% offered training on infection management and antibiotic prescribing for medical staff and nursing staff, respectively.
Participants positively perceived antibiotic stewardship and suggestions to improve stewardship in nursing homes, with the greatest interest in training for physicians, distribution of antibiotic prescribing guides, and audit and feedback.
“This survey shows that ABS [antibiotic stewardship] programmes are insufficiently implemented in French NHs [nursing homes], even though the medical and nurse coordinators who participated in this survey seemed aware this is a public health priority,” the study authors wrote.
While France does not require nursing homes to have stewardship programs, there are regional initiatives promoting stewardship. The authors suggest that core elements for nursing home stewardship be defined at a national level and that regional health authorities could then take a lead role in implementing those elements.
Aug 15 JAC-Antimicrob Resist study
Program linked to better antibiotic choice in penicillin-allergic patients
A low-cost intervention aimed at improving perioperative antimicrobial prophylaxis for patients with penicillin allergy was associated with higher use of cephalosporins and lower antibiotic costs, researchers reported today in Infection Control & Hospital Epidemiology.
The intervention at Emory University School of Medicine was based on the results of a survey of anesthesia providers at the hospital (who are responsible for perioperative antibiotic selection). It included a decision support algorithm that recommends cephalosporins (cefazolin or cefuroxime) for all patients without a history of severe delayed hypersensitivity reactions to penicillin, along with a screening questionnaire to help identify those patients. The survey results were also used to design two educational presentations to introduce the algorithm.
Analysis of patients who received perioperative antibiotics from January 2017 through August 2019 at the hospital showed that the percentage of penicillin-allergic patients receiving a cephalosporin increased from roughly 34% to more than 80% following implementation of the algorithm and the associated educational presentations. No severe adverse events were reported. There was also a reduction in second-line agents associated with the intervention that was accompanied by a 58% reduction in the antibiotic cost for each penicillin-allergic patient.
“These findings emphasize the ongoing need for strategies to risk-stratify patients with penicillin allergy labels so that they can receive appropriate targeted antimicrobial coverage,” the study authors write. “Our study results also suggest that transitioning penicillin-allergic patients to first-line therapy has significant benefits with respect to decreased use of higher-cost, less-effective second-line antibiotic agents.”
Aug 16 Infect Control Hosp Epidemiol abstract