Stewardship/Resistance Analysis July 14, 2022

Prior antibiotic use, longer hospital stays increase risk of CRE infections

A study of patients at a large tertiary care medical center found that exposure to antibiotics and length of stay were associated with an increased risk of developing carbapenem-resistant Enterobacteriaceae (CRE) infection, reported today. today researchers in Antimicrobial stewardship and healthcare epidemiology.

To identify risk factors for CRE infection, Ohio State researchers conducted a retrospective case-control study, comparing patients who were diagnosed with CRE infection in hospital from 2011 to 2016 with patients diagnosed with carbapenem-susceptible enterobacteriaceae (CSE) infections and a random selection of control patients. Data collected from patients’ medical records included age at admission, gender, length of hospital stay, and prescription of antibiotics within 90 days prior to admission.

A total of 81 unique CRE patients were identified during the study period, and they were compared to 87 CSE patients and 89 control patients. In the unadjusted analysis, CRE patients were more than 18 times more likely to have been prescribed an antibiotic in the past 90 days than CSE patients (odds ratio [OR], 6:35 p.m.; 95% confidence interval [CI]5.37 to 62.8) and 51 times more likely than control patients (OR, 51.1; 95% CI, 14.9 to 176.0).

In multivariate models, prescribing a beta-lactam antibiotic was associated with a fivefold increase in the risk of CRE infection (OR, 5.43; 95% CI, 1.95 to 15.1) and a more than double increase in the risk of CSE infection (OR, 2.65; 95% CI, 1.18 to 5.95). Each additional day of hospitalization was associated with an approximately 13% increased risk of infection for CRE patients (OR, 1.14; 95% CI, 1.08 to 1.19) and patients with CSE (OR, 1.13; 95% CI, 1.08 to 1.18) .

“Future studies of this type could consider conducting more in-depth reviews of medical records to determine the specific type of residence prior to admission and whether patients come from common locations that have previously seen patients diagnosed with CRE or CSE” , the study authors wrote. “Long-term care facilities and other group care settings may have an increased incidence of infections in general and resistant organisms in particular and determining where patients are admitted from may be an important factor in determining how to take care of such patients upon admission to a medical facility.”
July 14th Antimicrobial Stewardship Healthc Epidemiol study

Stewardship interventions related to antibiotic reduction in emergency care

A multifaceted quality improvement program implemented in urgent care clinics in an integrated academic health system was associated with reductions in inappropriate and overall antibiotic prescribing, without negatively affecting satisfaction of patients, researchers reported yesterday in Infection control and hospital epidemiology.

The 2019 program at Northwestern Medicine was developed by an outpatient antibiotic management committee and focused on improving antibiotic prescribing for “target management visits,” which included conditions not appropriate to antibiotics such as upper respiratory tract infections. The program also targeted “diagnosis change visits,” in which clinicians add appropriate diagnoses to antibiotics to evade management measures, overall antibiotic prescribing, and patient satisfaction for respiratory infection visits. acute (IRA). Interventions included comparative feedback and clinician and patient education.

From 2019 to 2021, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnostic change measures were implemented. been applied.

The rate of antibiotic prescribing decreased for stewardship measurement visits from 34% in 2019 to 12% in 2021 (absolute change, -22 percentage points; 95% CI, -23 to -22), for diagnosis change visits from 63% to 35% (-28 percentage points; 95% CI, -28 to -27). The overall antibiotic prescribing rate fell from 30% to 10% (−20 percentage points; 95% CI, −20 to −20). Patient satisfaction increased from 83% in 2019 to 89% in 2020 and 2021. There was no significant association between individual clinician antibiotic prescription rates and patient satisfaction in consultation for IRA.

“In conclusion, it is possible to reduce the prescription of antibiotics for suspected viral illnesses in the emergency care setting and maintain patient satisfaction,” the study authors wrote. “Key elements of success may have included an outpatient antimicrobial stewardship committee, physician champions, data for analysis and reporting, and educational resources for patients and prescribers.”

They added that reducing antibiotic prescribing for antibiotic-inappropriate diagnoses has the potential to trigger a “virtuous circle” for patients, as not receiving antibiotics may be associated with less drug seeking. antibiotics in the future.
Jul 13 Hosp Epidemiol Infection Control abstract

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