High-intensity antimicrobial stewardship may top low-intensity
A new study conducted in a 400-bed community hospital in Toronto shows that high-intensity prospective audit and feedback (PAF) was tied to a greater reduction in antimicrobial use than low-intensity interventions. The study appeared yesterday in Infection Control & Hospital Epidemiology.
According to the study authors, PAF is an evaluation of antimicrobial regimens by an infectious diseases or antimicrobial stewardship (ASP) clinician—with recommendations made to the prescriber to optimize antimicrobial use.
The study was conducted at St. Joseph's Health Centre from 2012 to 2016. Before the intervention, ASP pharmacists performed low-intensity PAF, via recommendations made on a per-patient basis to hospital internists. The high-intensity, rounds–based PAF initiative began in 2014 and included twice-weekly ASP rounds on the internal medicine wards from September 2014 through December 2015.
"Implementation of high-intensity PAF was associated with a 19% (adjusted analysis) reduction in overall antibiotic use compared to low-intensity PAF in our community teaching hospital without any changes in patient clinical outcomes," the authors said.
Prescriptions dropped from 483 defined daily doses (DDD) per 1,000 patient days (PD) during the low-intensity phase to 442 DDD/1,000 PD in the high-intensity phase.
Oct 22 Infect Control Hosp Epidemiol study
High antibiotic prescribing levels, provider variability noted in urgent care
An analysis of visits to urgent care clinics that are part of a large healthcare system found high levels of antibiotic prescribing, much of it for respiratory conditions, with provider variability in prescribing that was also high. A team led by researchers from Intermountain Healthcare in Salt Lake City, Utah, reported their findings today in Clinical Infectious Diseases.
Given that urgent care visits are increasing and are known to involve high rates of inappropriate antibiotic prescribing, the group said its goal was to identify patterns within urgent care settings that are part of a large integrated health system.
The retrospective cohort study took place at Intermountain Healthcare's 38 urgent care clinics from August 2017 through June 2019. Of 1.16 million urgent care encounters, antibiotics were prescribed during 34% of visits, with respiratory conditions accounting for 61% all antibiotics that providers prescribed.
Of visits for respiratory conditions, 50% resulted in antibiotic prescriptions. However, levels by provider varied from 3% to 94%. The group also saw similar prescribing variability among providers for respiratory conditions in which antibiotics weren't indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis.
They said antibiotic prescribing at Intermountain healthcare's urgent care clinics was similar to the 39% national level.
"Collectively, these findings support the importance of integrating antibiotic stewardship principles into UC settings and developing interventions specifically targeting UC [urgent care] settings," the authors write. They added that tier 2 respiratory conditions—including pharyngitis, sinusitis, and otitis media—accounted for more than half of all respiratory conditions, suggesting that stewardship interventions that target those illnesses have the potential for substantial impact by ensuring appropriate diagnosis, using delayed prescriptions for sinusitis and ear infection, and promoting appropriate antibiotic selection.
Oct 23 Clin Infect Dis abstract
