Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/11/stewardship-resistance-scan-nov-01-2019
Stewardship / Resistance Scan for Nov 01, 2019
NICU quality improvement; Antibiotic data comparisons; Expert opinion on resistant TB
Filed Under:
Antimicrobial Stewardship; MRSA; Tuberculosis
[h=3]NICU quality improvement steps tied to CDC compliance, fewer antibiotics[/h] Neonatal intensive care units (NICUs) participating in a quality improvement (QI) collaborative increased adherence to the US Centers for Disease Control and Prevention (CDC) core elements of antibiotic stewardship dramatically and cut antibiotic use by a third, according to a study today in Pediatrics.
US scientists, including CDC researchers, analyzed data from 146 NICUs across the country who participated in a multidisciplinary initiative called Choosing Antibiotics Wisely, an Internet-based national QI collaborative consisting of interactive Web sessions, four point-prevalence audits, and expert coaching designed to help teams test and implement the CDC core elements of antibiotic stewardship. The seven CDC core elements encompass varying aspects of stewardship, such as leadership, accountability, and education. The audits tracked unit-level adherence to the core elements and antibiotic use.
Of the 146 NICUs, 122 (83.6%) participated in both study years—2016 and 2017—and 85 (69.7%) of the centers participated in all four audits.
The investigators found that the percentage of NICUs implementing the CDC core elements increased in each of the seven domains (leadership, 15.4%–68.8%; accountability, 54.5%–95%; drug expertise, 61.5%–85.1%; actions, 21.7%–72.3%; tracking, 14.7%–78%; reporting, 6.3%–17.7%; education, 32.9%–87.2%; P < .005 for all measures). And the median rate of antibiotic use decreased from 16.7% to 12.1% (P for trend < .0013), a 34% decline.
The authors conclude, "As in many collaborative QI initiatives, not all of the teams were able to achieve all of the goals (including the fact that only 9.9% of NICUs met all the CDC core elements), leaving further opportunities for improvement."
Nov 1 Pediatrics abstract
[h=3]Drop in antimicrobial use seen with VA comparative data visualization tool[/h] A study today in Clinical Infectious Diseases involving eight geographically dispersed Veterans Affairs (VA) medical centers finds that use of comparative data visualization tools by antibiotic stewards in a pilot implementation project was associated with significant reductions in overall antimicrobial and anti-pseudomonal use compared with uninvolved facilities.
In the pilot program, antibiotic stewards from the eight hospitals used the visualization tools, which consisted of an interactive web-based antimicrobial dashboard and, later, a standardized antimicrobial usage report updated at user-selected intervals. Following tool implementation, stewards participated in monthly learning collaboratives. VA researchers then compared outcomes at the eight facilities compared with other VA hospitals nationwide.
They determined that intervention sites demonstrated a 2.1% decrease (95% confidence interval [CI], -5.7% to 1.6%) in total antimicrobial use, versus a 2.5% increase (95% CI, 0.8% to 4.1%) in non-intervention sites (absolute difference, 4.6 percentage points; P = 0.025). Anti-pseudomonal antimicrobial use decreased 3.4% (95% CI, -8.2% to 1.7%) at intervention sites, versus a 3.4% increase (95% CI, 0.8% to 6.5%) at non-intervention sites (absolute difference, 7.0 percentage points; P = 0.018). Antimicrobial use against methicillin-resistant Staphylococcus aureus declined 11.3% (95% CI, -16.0% to -6.3%) at intervention sites, versus a 6.6% drop (95% CI, -9.1% to -3.9%) at non-intervention sites (absolute difference, 4.7 percentage points; P = 0.092).
The authors conclude, "While we cannot directly attribute the decreases in antimicrobial use to stewards' use of the antimicrobial graphic tools, we hypothesize that the overall implementation strategy and follow-up served to activate stewards to pursue interventions that focused on the particular needs of their facilities."
In a commentary on the study in the same issue, Payal Patel, MD, MPH, with the University of Michigan, said, "Large collaboratives and healthcare systems can outline a common antimicrobial stewardship target, but tailored interventions to arrive at that goal will help complement the needs and strengths of individual facilities."
Nov 1 Clin Infect Dis study
Nov 1 Clin Infect Dis commentary
[h=3]WHO Europe issues expert opinion on drug-resistant TB in kids, teens[/h] The World Health Organization's (WHO's) European office released an evidence-based expert opinion on managing drug-resistant tuberculosis (DR-TB) in children and adolescents, recommending the use of bedaquiline if necessary in those 6 years and older.
Dr Masoud Dara, the coordinator of communicable diseases with WHO Europe, said in a news release yesterday, "In public health terms, this is an important step towards addressing a future reservoir of DR-TB that could prolong the epidemic. From a human perspective, these are children robbed of significant parts of their childhood by a severe disease."
In addition to the bedaquiline advice, the expert opinion, published as a commentary in The Lancet Child & Adolescent Health, also recommends delamanid, another fairly new DR-TB drug, for children 3 years old and older.
WHO Europe estimates that 2,000 children under age 15 in the WHO European Region who have TB remain undiagnosed each year, and the figure is likely higher in older teens. Of those infected, the agency said, 14% have "especially dangerous and hard-to-treat forms of TB," which raises the risk that those who are undiagnosed with DR-TB will unknowingly spread the disease.
The agency said in the release that the guidance "will act as a cornerstone of WHO/Europe's efforts to end TB for everyone including children and adolescents."
Oct 31 WHO Europe news release
Oct 29 Lancet Child Adolesc Health commentary
Stewardship / Resistance Scan for Nov 01, 2019
NICU quality improvement; Antibiotic data comparisons; Expert opinion on resistant TB
Filed Under:
Antimicrobial Stewardship; MRSA; Tuberculosis
[h=3]NICU quality improvement steps tied to CDC compliance, fewer antibiotics[/h] Neonatal intensive care units (NICUs) participating in a quality improvement (QI) collaborative increased adherence to the US Centers for Disease Control and Prevention (CDC) core elements of antibiotic stewardship dramatically and cut antibiotic use by a third, according to a study today in Pediatrics.
US scientists, including CDC researchers, analyzed data from 146 NICUs across the country who participated in a multidisciplinary initiative called Choosing Antibiotics Wisely, an Internet-based national QI collaborative consisting of interactive Web sessions, four point-prevalence audits, and expert coaching designed to help teams test and implement the CDC core elements of antibiotic stewardship. The seven CDC core elements encompass varying aspects of stewardship, such as leadership, accountability, and education. The audits tracked unit-level adherence to the core elements and antibiotic use.
Of the 146 NICUs, 122 (83.6%) participated in both study years—2016 and 2017—and 85 (69.7%) of the centers participated in all four audits.
The investigators found that the percentage of NICUs implementing the CDC core elements increased in each of the seven domains (leadership, 15.4%–68.8%; accountability, 54.5%–95%; drug expertise, 61.5%–85.1%; actions, 21.7%–72.3%; tracking, 14.7%–78%; reporting, 6.3%–17.7%; education, 32.9%–87.2%; P < .005 for all measures). And the median rate of antibiotic use decreased from 16.7% to 12.1% (P for trend < .0013), a 34% decline.
The authors conclude, "As in many collaborative QI initiatives, not all of the teams were able to achieve all of the goals (including the fact that only 9.9% of NICUs met all the CDC core elements), leaving further opportunities for improvement."
Nov 1 Pediatrics abstract
[h=3]Drop in antimicrobial use seen with VA comparative data visualization tool[/h] A study today in Clinical Infectious Diseases involving eight geographically dispersed Veterans Affairs (VA) medical centers finds that use of comparative data visualization tools by antibiotic stewards in a pilot implementation project was associated with significant reductions in overall antimicrobial and anti-pseudomonal use compared with uninvolved facilities.
In the pilot program, antibiotic stewards from the eight hospitals used the visualization tools, which consisted of an interactive web-based antimicrobial dashboard and, later, a standardized antimicrobial usage report updated at user-selected intervals. Following tool implementation, stewards participated in monthly learning collaboratives. VA researchers then compared outcomes at the eight facilities compared with other VA hospitals nationwide.
They determined that intervention sites demonstrated a 2.1% decrease (95% confidence interval [CI], -5.7% to 1.6%) in total antimicrobial use, versus a 2.5% increase (95% CI, 0.8% to 4.1%) in non-intervention sites (absolute difference, 4.6 percentage points; P = 0.025). Anti-pseudomonal antimicrobial use decreased 3.4% (95% CI, -8.2% to 1.7%) at intervention sites, versus a 3.4% increase (95% CI, 0.8% to 6.5%) at non-intervention sites (absolute difference, 7.0 percentage points; P = 0.018). Antimicrobial use against methicillin-resistant Staphylococcus aureus declined 11.3% (95% CI, -16.0% to -6.3%) at intervention sites, versus a 6.6% drop (95% CI, -9.1% to -3.9%) at non-intervention sites (absolute difference, 4.7 percentage points; P = 0.092).
The authors conclude, "While we cannot directly attribute the decreases in antimicrobial use to stewards' use of the antimicrobial graphic tools, we hypothesize that the overall implementation strategy and follow-up served to activate stewards to pursue interventions that focused on the particular needs of their facilities."
In a commentary on the study in the same issue, Payal Patel, MD, MPH, with the University of Michigan, said, "Large collaboratives and healthcare systems can outline a common antimicrobial stewardship target, but tailored interventions to arrive at that goal will help complement the needs and strengths of individual facilities."
Nov 1 Clin Infect Dis study
Nov 1 Clin Infect Dis commentary
[h=3]WHO Europe issues expert opinion on drug-resistant TB in kids, teens[/h] The World Health Organization's (WHO's) European office released an evidence-based expert opinion on managing drug-resistant tuberculosis (DR-TB) in children and adolescents, recommending the use of bedaquiline if necessary in those 6 years and older.
Dr Masoud Dara, the coordinator of communicable diseases with WHO Europe, said in a news release yesterday, "In public health terms, this is an important step towards addressing a future reservoir of DR-TB that could prolong the epidemic. From a human perspective, these are children robbed of significant parts of their childhood by a severe disease."
In addition to the bedaquiline advice, the expert opinion, published as a commentary in The Lancet Child & Adolescent Health, also recommends delamanid, another fairly new DR-TB drug, for children 3 years old and older.
WHO Europe estimates that 2,000 children under age 15 in the WHO European Region who have TB remain undiagnosed each year, and the figure is likely higher in older teens. Of those infected, the agency said, 14% have "especially dangerous and hard-to-treat forms of TB," which raises the risk that those who are undiagnosed with DR-TB will unknowingly spread the disease.
The agency said in the release that the guidance "will act as a cornerstone of WHO/Europe's efforts to end TB for everyone including children and adolescents."
Oct 31 WHO Europe news release
Oct 29 Lancet Child Adolesc Health commentary