Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/10/stewardship-resistance-scan-oct-20-2020
Stewardship / Resistance Scan for Oct 20, 2020
VA antibiotic use during COVID-19; Shorter pneumonia therapy
Filed Under:
Antimicrobial Stewardship; Pneumonia
VA study finds increased antibiotic use during early months of COVID-19
Data from inpatient Veterans Administration (VA) hospitals show a significant increase in antibiotic use from January to May, largely negating a downward trend over the previous 5 years, researchers reported today in Infection Control and Hospital Epidemiology.
To provide a broad overview of changes in antibiotic use at VA facilities during the COVID-19 pandemic, researchers examined data from acute inpatient care units at 84 VA facilities from 2015 through 2020, using only data from Jan 1 to May 31 of each year. They measured the impact in days of therapy (DOT) per 1,000 days-present (DP), but also examined the changes in the total antibiotic DOT to account for decreases in healthcare use during the pandemic.
From 2015 through 2019, antibiotic use decreased each year for Jan 1 to May 31 from 638 to 602 DOT/1,000 PD, a mean decrease of 9.1 DOT/1,000 PD per year. Consistent year-to-year declines were observed for broad-spectrum agents for community-onset infections, broad-spectrum agents for hospital-onset infections, and agents used for antibiotic-resistant gram-positive infections.
In contrast, the same period in 2020 saw antibiotic use increase from 602 to 628 DOT/1,000 PD, with increases observed for broad-spectrum agents used for community-onset and hospital-onset infections. The largest increase in the rate of use was for antibiotics typically prescribed for empiric therapy for community-acquired pneumonia (CAP). Total antibiotic DOT decreased from 721,761 in 2019 to 643,455 in 2020, likely because of a decline in DP (a 14.5% decline from 2019 to 2020) linked to fewer elective procedures and fewer emergency department visits.
A subset analysis that excluded VA facilities in states that were hit hard early in the pandemic showed similar results.
The authors say that while overall institutional antibiotic use fell, the increased density of antibiotic use (as measured by the use per patient per day) may adversely affect patient outcomes and institutional antibiotic resistance patterns.
Oct 20 Infect Control Hosp Epidemiol abstract
Clinical decision support tied to improved antibiotic use for pneumonia
A single-center study found that a clinical decision support (CDS) tool supplemented by antimicrobial stewardship program (ASP) audit and feedback led to robust improvements in antibiotic use for pneumonia patients, University of Utah researchers reported yesterday in Open Forum Infectious Diseases.
The study, conducted at the University of Utah Hospital, was a pre-post intervention analysis of inpatients with pneumonia that evaluated a CAP pathway built around a CDS advisory that aimed to help providers identify appropriate antibiotic therapy for CAP patients on admission, promote early transition from intravenous (IV) to oral therapy, and shorten overall durations of antibiotic therapy.
The study compared three 6-month phases of intervention—education alone, education and a CDS-driven CAP pathway coupled with active ASP and provider feedback, and a CDS-driven CAP pathway without stewardship—with the 12 months preceding the interventions. The primary outcomes were length of intravenous (IV) antibiotic therapy and total antibiotic therapy. Secondary outcomes included clinical, process, and cost outcomes.
A total of 400 CAP patients were included in the baseline period and 623 in the intervention phases. When compared to the baseline period, length of IV antibiotic therapy and total antibiotic therapy was unchanged in phase 1, while phase 2 of the intervention was associated with significantly lower length of IV and total antibiotic therapy, higher procalcitonin lab use, and a 20% cost reduction. Phase 3 was also associated with shorter IV antibiotic therapy and increased procalcitonin testing, and a non-significant reduction of 16% in costs.
There was no change in inpatient mortality or 30-day readmissions between any of the phases.
The authors attribute the success of phase 2 to its being the most intensive, with the ASP conducting prospective audit and feedback of all CAP patients in addition to using the CAP pathway.
"The early initiation of a CDS-driven CAP pathway supplemented by ASP review appears to improve healthcare value through decreased IV antibiotic length of therapy, decreased total length of therapy and decreased costs with similar clinical outcomes," the authors wrote.
Oct 19 Open Forum Infect Dis abstract
Stewardship / Resistance Scan for Oct 20, 2020
VA antibiotic use during COVID-19; Shorter pneumonia therapy
Filed Under:
Antimicrobial Stewardship; Pneumonia
VA study finds increased antibiotic use during early months of COVID-19
Data from inpatient Veterans Administration (VA) hospitals show a significant increase in antibiotic use from January to May, largely negating a downward trend over the previous 5 years, researchers reported today in Infection Control and Hospital Epidemiology.
To provide a broad overview of changes in antibiotic use at VA facilities during the COVID-19 pandemic, researchers examined data from acute inpatient care units at 84 VA facilities from 2015 through 2020, using only data from Jan 1 to May 31 of each year. They measured the impact in days of therapy (DOT) per 1,000 days-present (DP), but also examined the changes in the total antibiotic DOT to account for decreases in healthcare use during the pandemic.
From 2015 through 2019, antibiotic use decreased each year for Jan 1 to May 31 from 638 to 602 DOT/1,000 PD, a mean decrease of 9.1 DOT/1,000 PD per year. Consistent year-to-year declines were observed for broad-spectrum agents for community-onset infections, broad-spectrum agents for hospital-onset infections, and agents used for antibiotic-resistant gram-positive infections.
In contrast, the same period in 2020 saw antibiotic use increase from 602 to 628 DOT/1,000 PD, with increases observed for broad-spectrum agents used for community-onset and hospital-onset infections. The largest increase in the rate of use was for antibiotics typically prescribed for empiric therapy for community-acquired pneumonia (CAP). Total antibiotic DOT decreased from 721,761 in 2019 to 643,455 in 2020, likely because of a decline in DP (a 14.5% decline from 2019 to 2020) linked to fewer elective procedures and fewer emergency department visits.
A subset analysis that excluded VA facilities in states that were hit hard early in the pandemic showed similar results.
The authors say that while overall institutional antibiotic use fell, the increased density of antibiotic use (as measured by the use per patient per day) may adversely affect patient outcomes and institutional antibiotic resistance patterns.
Oct 20 Infect Control Hosp Epidemiol abstract
Clinical decision support tied to improved antibiotic use for pneumonia
A single-center study found that a clinical decision support (CDS) tool supplemented by antimicrobial stewardship program (ASP) audit and feedback led to robust improvements in antibiotic use for pneumonia patients, University of Utah researchers reported yesterday in Open Forum Infectious Diseases.
The study, conducted at the University of Utah Hospital, was a pre-post intervention analysis of inpatients with pneumonia that evaluated a CAP pathway built around a CDS advisory that aimed to help providers identify appropriate antibiotic therapy for CAP patients on admission, promote early transition from intravenous (IV) to oral therapy, and shorten overall durations of antibiotic therapy.
The study compared three 6-month phases of intervention—education alone, education and a CDS-driven CAP pathway coupled with active ASP and provider feedback, and a CDS-driven CAP pathway without stewardship—with the 12 months preceding the interventions. The primary outcomes were length of intravenous (IV) antibiotic therapy and total antibiotic therapy. Secondary outcomes included clinical, process, and cost outcomes.
A total of 400 CAP patients were included in the baseline period and 623 in the intervention phases. When compared to the baseline period, length of IV antibiotic therapy and total antibiotic therapy was unchanged in phase 1, while phase 2 of the intervention was associated with significantly lower length of IV and total antibiotic therapy, higher procalcitonin lab use, and a 20% cost reduction. Phase 3 was also associated with shorter IV antibiotic therapy and increased procalcitonin testing, and a non-significant reduction of 16% in costs.
There was no change in inpatient mortality or 30-day readmissions between any of the phases.
The authors attribute the success of phase 2 to its being the most intensive, with the ASP conducting prospective audit and feedback of all CAP patients in addition to using the CAP pathway.
"The early initiation of a CDS-driven CAP pathway supplemented by ASP review appears to improve healthcare value through decreased IV antibiotic length of therapy, decreased total length of therapy and decreased costs with similar clinical outcomes," the authors wrote.
Oct 19 Open Forum Infect Dis abstract