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CIDRAP Stewardship / Resistance Scan: Canadian stewardship success; Stand-by antibiotics; Individualized risk assessment; Carbapenem-focused stewardship

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  • CIDRAP Stewardship / Resistance Scan: Canadian stewardship success; Stand-by antibiotics; Individualized risk assessment; Carbapenem-focused stewardship

    Source: http://www.cidrap.umn.edu/news-persp...an-jun-13-2018


    Stewardship / Resistance Scan for Jun 13, 2018
    Canadian stewardship success; Stand-by antibiotics; Individualized risk assessment; Carbapenem-focused stewardship

    Filed Under:
    Antimicrobial Stewardship

    Study links lower hospital antibiotic use with ASP components

    An observational study of Canadian hospitals found that certain structural and strategic components of antimicrobial stewardship programs (ASPs) are associated with lower antibiotic use, a team of Canadian researchers reported yesterday in Infection Control and Hospital Epidemiology.
    The study used a survey and data on antibiotic use to determine the relationship between ASP components and antibiotic use. The Ontario ASP Landscape Survey, developed by Public Health Ontario and sent to hospitals across the country, asked the clinicians most responsible for stewardship at their institution about eight structural and 32 strategic components of their ASP. Researchers used hospital purchasing data from 2014 to determine the crude and adjusted defined daily doses (DDD) of antibiotics per 1,000 patient-days across facilities. They then compared the rate ratios (RRs) of DDD per 1,000 patient-days for hospitals with and without each ASP component of interest.
    Of 127 eligible hospitals, 73 (57%) participated in the study. A sevenfold difference in antibiotic use across hospitals was observed, ranging from 253 to 1,872 DDD per 1,000 patient-days. After adjustment for hospital and patient characteristics, the only structural component associated with lower risk-adjusted antibiotic use was the presence of designated ASP funding or resources (adjusted RR 0.87).
    Of the strategic components on the survey, only prospective audit and feedback (adjusted RR, 0.80) and intravenous-to-oral conversion policies (adjusted RR, 0.79) were associated with lower risk-adjusted antibiotic use. No association between the overall number of ASP components and antibiotic use was found.
    The authors say the study offers important considerations for ASPs in hospital settings.
    Jun 12 Infect Control Hosp Epidemiol study

    'Stand-by' antibiotics encourage unwarranted use, study finds

    Finnish researchers report that carriage of "stand-by" antibiotics for travelers' diarrhea (TD) encouraged less cautious use of antibiotics, according to a new study in Travel Medicine and Infectious Disease.
    The researchers reviewed questionnaires and health diaries filled out by 316 Finnish volunteers who had traveled to subtropical locations and acquired TD on their trip. The questionnaires included 103 multiple-choice or open-ended questions, and the health diaries collected information on symptoms, severity of illness, duration of symptoms, and antibiotic use. Multivariable analysis was applied to identify factors associated with antibiotic use.
    Of the 316 travelers, 53 (17%) were carrying stand-by antibiotics. Antibiotic use was more frequent in the stand-by antibiotic carriers (34%) than non-carriers (11%). While antibiotics were taken equally for severe and incapacitating TD, more stand-by antibiotic carriers resorted to medication for mild/moderate symptoms (38% vs. 4%) and non-incapacitating disease (29% vs. 5%). All travelers with stand-by antibiotics had been advised to use them only for TD symptoms they considered severe.
    Multivariable analysis showed that antibiotic use was associated with stand-by antibiotic carriage (odds ratio [OR], 7.2), vomiting (OR, 3.5), incapacitating diarrhea (OR, 3.6), age (OR, 1.03), and healthcare visits for diarrhea (OR, 465.3). The rate of travelers' diarrhea–related healthcare did not differ significantly between stand-by antibiotic carriers and non-carriers (3.8% vs. 6.1%)
    The authors say the results are significant because stand-by antibiotics have long been prescribed for travel, with the assumption that it would decrease the rate of seeking healthcare abroad. But carrying stand-by antibiotics did not appear to significantly discourage medical visits. In addition, stand-by antibiotic carriers were less cautious with their antibiotic use, using the drugs mainly in cases of non-severe and non-incapacitating diarrhea.
    They conclude, "To cut back on unwarranted use of antibiotics for TD, new approaches need to be explored."
    Jun 9 Travel Med Infect Dis abstract

    Individualized risk assessment tied to lower antibiotic use

    A single center study found that an individualized risk assessment strategy for multidrug-resistant (MDR) organisms that uses a clinical prediction score for pneumonia can decrease the use of broad-spectrum antibiotics without an increase in adverse outcomes, researchers reported in the Journal of Antimicrobial Chemotherapy.
    Researchers at Mount Sinai West in New York City reviewed the records of 102 patients admitted for community-onset pneumonia before and after the implementation of a risk assessment program for MDR organisms that uses the drug resistance in pneumonia (DRIP) score. The primary aim was to identify the effects of this intervention on antibiotic days of therapy (DOT), and secondary outcomes included all-cause readmissions and time to clinical improvement.
    The investigators found that the program was associated with a decrease in broad-spectrum antimicrobials for treating methicillin-related Staphylococcus aureus (MRSA) and for pseudomonads, without an increase in adverse outcomes. It was not, however, tied to significantly lower odds of readmission or time to clinical improvement.
    Jun 11 J Antimicrob Chemother abstract

    Requiring carbapenem justification may lower its use, study finds

    A stewardship-targeted justification requirement for computerized physician order entry reduced days of carbapenem use by 34% in 23 hospitals, according to a new study in the Clinical Pharmacy Research Report.
    Researchers with Sanford Medical Center in Fargo, N.D., measured carbapenem days of therapy (DOT) after the stewardship intervention was implemented in the 23 medical centers. The program required physicians to justify carbapenem use in the electronic health record. The team compared periods from Dec 1, 2015, to Mar 31, 2016, and from Dec 1, 2016, to Mar 31, 2017.
    They found that carbapenem use dropped from 35.8 DOT per 1,000 patient-days to 23.7 DOT per 1,000 patient-days, a 33.8% reduction. Morbidity, mortality, and resistance rates remained unchanged.
    The authors conclude, "This study suggests that a stewardship-targeted justification requirement in computerized physician order entry is an effective approach to reducing carbapenem utilization."
    Jun 11 Clin Pharm Res Rep study



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