Stewardship / Resistance Scan for Feb 12, 2019

Staph bacteremia and hospital readmission
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Hospital ASP cost savings
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UK, African hospitals partner on stewardship

Study: Hospital readmission for Staph bacteremia patients common, costly

New research by scientists with the University of Mississippi Medical Center indicates that 30-day hospital readmission among patients who survived initial hospitalization with Staphylococcus aureus bloodstream infections is common and costly. The findings appeared yesterday in Clinical Infectious Diseases.

Using the 2014 Nationwide Readmissions Database, the researchers examined 30-day readmission, mortality, length of stay, and costs associated with initial hospitalization for methicillin-susceptible and methicillin-resistant S aureus (MSSA and MRSA) bacteremia. Although research on mortality from S aureus bacteremia is extensive, less is known about hospital readmission, and greater understanding of readmission, and its risk factors, could result in improved patient care.

From January 2014 through November 2014, the researchers identified 92,089 patients with S aureus bacteremia, 48.5% of whom had MRSA bacteremia. The all-cause 30-day readmission rate was 22% overall, with no significant difference between MRSA and MSSA cases. But patients with MRSA bacteremia were 17% more likely to have 30-day readmission with S aureus bacteremia recurrence (hazard ratio, 1.17; 95% confidence interval [CI], 1.02 to 1.35). In addition, patients with MRSA bacteremia had higher in-hospital mortality (odds ratio,1.15; 95% CI, 1.07 to 1.22), and longer hospital stays (incidence rate ratio, 1.08; 95% CI, 1.06 to 1.11).

Readmission with bacteremia recurrence was particularly associated with endocarditis, congestive heart failure, end stage renal failure, underlying immunocompromising comorbidities, and drug abuse. The mean overall cost of readmission was $12,425 per patient, and $19,186 per patient in those with bacteremia recurrence.

The authors of the study conclude, "Efforts should continue to optimize patient care, particularly for those with risk factors for readmission, to decrease readmissions and associated morbidity and mortality in the context of S aureus bacteremia."
Feb 11 Clin Infect Dis abstract

 

Review of hospital stewardship programs finds economic impacts

A systematic review of previous research suggests that hospital antimicrobial stewardship programs (ASPs) help save costs by decreasing length of stay and antibiotic expenditures.

The review, published today in Antimicrobial Resistance and Infection Control, looked at studies published from 2000 through 2017 that evaluated patient and/or economic outcomes after implementation of hospital ASPs. Key economic outcomes were costs associated with antibiotics, length of stay, and total costs (including operation and implementation). A total of 146 primary research studies were included on the final analysis, the majority of which were conducted in 500-1,000 bed hospitals in North America (49%), Europe (25%), and Asia (14%).

Of the studies that evaluated length of stay and antibiotic expenditure, 85% (58 of 68 studies) showed a reduction in length of stay and 92% (80 of 87 studies) showed a decrease in antimicrobial costs following ASP implementation. Average cost savings were $732 per patient in US studies and €198 per patient ($224 US) in European studies, with length of stay being a key driver of cost savings. Savings were higher among hospitals with ASPs that included therapy review and antibiotic restrictions.

"Overall, this systematic review demonstrates that ASPs can offset or reduce costs while improving some patient outcomes, thereby suggesting high value for certain healthcare systems," the authors of the review write. "However, for the findings to be globally relevant, more studies, particularly in real world settings across a diverse range of geographies and resource settings are required, so that a full critical appraisal of the true value of these programs can be made."
Feb 12 Antimicrob Resist Infect Control study

 

Fleming Fund selects UK partners for African stewardship program

The Fleming Fund, a UK government aid program to help low- and middle-income countries fight antimicrobial resistance (AMR), today announced the 12 hospitals and research institutions that will work with partners in four African countries to promote antimicrobial stewardship.

Through the Commonwealth Partnerships for Antimicrobial Stewardship program, clinicians, nurses and pharmacists from 12 National Health Service (NHS) trusts and UK academic institutions will work with partner teams in hospitals in Ghana, Tanzania, Uganda, and Zambia to improve stewardship practices and protocols and develop tools that help reduce the spread of AMR. The winners were chosen for their strong records in antimicrobial stewardship.

"The quality of all the proposals received was extremely high and the selected NHS teams will make a great impact working in partnership with teams on stewardship practices across Africa," Keith Ridge, England's Chief Pharmaceutical Officer, said in a press release.

The Fleming Fund will provide £1.3 million ($1.68 million US) to support the projects, which will last up to 15 months.
Feb 12 Fleming Fund press release

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