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News Scan for Aug 30, 2022
Stewardship for asymptomatic bacteriuria, pyuria;
Illinois Heartland virus case
Filed Under:
Heartland Virus;
Antimicrobial Stewardship;
Tick-borne Disease
Stewardship tied to reduced inappropriate antibiotics for asymptomatic urinary issues
A single-center study in North Carolina showed that a multifaceted initiative was associated with a significant and sustainable decrease in inappropriate antibiotic prescribing for patients with asymptomatic bacteriuria (ASB; bacteria in the urine) and asymptomatic pyuria (ASP; elevated white blood cells in the urine), researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.
The initiative, implemented in the emergency department (ED) of Wake Forest Baptist Medical Center in 2015, included verbal presentations for physicians and pharmacists, distribution of pocket cards and treatment algorithms, alerts embedded into order-entry software for urine cultures, and elimination of reflex urine-culture orders for positive urinalysis.
To determine the effectiveness, the researchers assessed the proportion of patients with ASP and ASB who were prescribed antibiotics within 72 hours of discharge from the ED in the preintervention period (August to October 2015) and two postintervention periods (December 2016 to February 2017, and November 2019 to January 2020).
The intervention was tied to a dramatic reduction in inappropriate prescribing for ASB and ASP, from 100% in the preintervention period to 32.4% in postintervention group 1. No change in the proportion of inappropriate prescribing was observed 3 years later, with 28% of patients receiving antibiotics for ASP and/or ASB in postintervention group 2. The analysis also found that withholding antibiotics for ASP or ASB did not increase the risk of returning to the ED with a symptomatic urinary tract infection within 30 days of discharge.
"These results suggest that there is no apparent harm from refraining from treatment of asymptomatic patients," the study authors wrote.
Aug 30 Antimicrob Steward Healthc Epidemiol study
Illinois reports Heartland virus infection
The Illinois Department of Public Health (IDPH) last week reported a Heartland virus infection in a patient from Jackson County, marking the state's third case of the tick-borne disease but its first since 2018.
In a statement, the IDPH said the individual is an older person who lives in a rural area. Jackson County is in southern Illinois. The state's two earlier cases occurred in people from Kankakee County, just south of Chicago, and Williamson County, also in southern Illinois.
Heartland virus infections are spread by Amblyomma americanaum lone star ticks. Cases have been reported in 11 states, mostly in the Southeast and Midwest, according to the Centers for Disease Control and Prevention (CDC). Symptoms can include fever, fatigue, leukopenia, and thrombocytopenia. Hospitalizations are frequent, and some deaths have been reported.
Aug 23 IDPH statement
CDC background on Heartland virus
News Scan for Aug 30, 2022
Stewardship for asymptomatic bacteriuria, pyuria;
Illinois Heartland virus case
Filed Under:
Heartland Virus;
Antimicrobial Stewardship;
Tick-borne Disease
Stewardship tied to reduced inappropriate antibiotics for asymptomatic urinary issues
A single-center study in North Carolina showed that a multifaceted initiative was associated with a significant and sustainable decrease in inappropriate antibiotic prescribing for patients with asymptomatic bacteriuria (ASB; bacteria in the urine) and asymptomatic pyuria (ASP; elevated white blood cells in the urine), researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.
The initiative, implemented in the emergency department (ED) of Wake Forest Baptist Medical Center in 2015, included verbal presentations for physicians and pharmacists, distribution of pocket cards and treatment algorithms, alerts embedded into order-entry software for urine cultures, and elimination of reflex urine-culture orders for positive urinalysis.
To determine the effectiveness, the researchers assessed the proportion of patients with ASP and ASB who were prescribed antibiotics within 72 hours of discharge from the ED in the preintervention period (August to October 2015) and two postintervention periods (December 2016 to February 2017, and November 2019 to January 2020).
The intervention was tied to a dramatic reduction in inappropriate prescribing for ASB and ASP, from 100% in the preintervention period to 32.4% in postintervention group 1. No change in the proportion of inappropriate prescribing was observed 3 years later, with 28% of patients receiving antibiotics for ASP and/or ASB in postintervention group 2. The analysis also found that withholding antibiotics for ASP or ASB did not increase the risk of returning to the ED with a symptomatic urinary tract infection within 30 days of discharge.
"These results suggest that there is no apparent harm from refraining from treatment of asymptomatic patients," the study authors wrote.
Aug 30 Antimicrob Steward Healthc Epidemiol study
Illinois reports Heartland virus infection
The Illinois Department of Public Health (IDPH) last week reported a Heartland virus infection in a patient from Jackson County, marking the state's third case of the tick-borne disease but its first since 2018.
In a statement, the IDPH said the individual is an older person who lives in a rural area. Jackson County is in southern Illinois. The state's two earlier cases occurred in people from Kankakee County, just south of Chicago, and Williamson County, also in southern Illinois.
Heartland virus infections are spread by Amblyomma americanaum lone star ticks. Cases have been reported in 11 states, mostly in the Southeast and Midwest, according to the Centers for Disease Control and Prevention (CDC). Symptoms can include fever, fatigue, leukopenia, and thrombocytopenia. Hospitalizations are frequent, and some deaths have been reported.
Aug 23 IDPH statement
CDC background on Heartland virus
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