Stewardship / Resistance Scan for Jan 24, 2022

Non-adherence to C diff guidelines
Pandemic decline in urgent care antibiotics

Study highlights non-guideline adherent antibiotic treatment for C diff

A review of Clostridioides difficile infection (CDI) treatments at 10 community hospitals found that only 50% of treatment regimens were adherent to guidelines regarding use of fidaxomicin, researchers reported today in Infection Control & Hospital Epidemiology.

The review looked at all adult non-hospice patients with confirmed CDI who received fidaxomicin at 10 community hospitals within the University of Pittsburgh Medical Center (UPMC) system from May 2018 through August 2019. Based on updated CDI treatment guidelines from Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, UPMC in April 2018 broadened fidaxomicin use but did not recommend it for initial treatment of CDI.

The aim of the study was to better understand fidaxomicin use following introduction of the updated UPMC guidelines, which were communicated to pharmacy directors and local antimicrobial stewardship programs at all UPMC hospitals.

Average fidaxomicin use remained low but increased by 30% pre-updated guidelines to post-updated guidelines. Of the 104 fidaxomicin regimens prescribed, 52 were non-adherent to UPMC guidelines. The main reasons for non-adherence included use for fulminant CDI (36 prescriptions) and concurrent use with other CDI treatment (29), neither of which were recommended at the time by the UPMC guidelines. Infectious disease (ID) physicians accounted for 25 (48%) of the 52 non-adherent regimens.

The study authors say the findings highlight the importance of including ID consultants in antimicrobial stewardship programs.

"Although release of new or updated clinical guidelines provides opportunities to advance patient care, dissemination of this information is often slow," they write. "Antimicrobial stewardship programs play a critical role in dissemination and should ensure that all providers, including ID staff, exercise appropriate stewardship in their prescribing practices."
Jan 24 Infect Control Hosp Epidemiol abstract


Urgent care study finds decline in antibiotic prescribing during COVID-19

An analysis of antibiotic prescribing at two academic urgent care clinics found a sustained decline in antibiotic prescribing during the COVID-19 pandemic, despite a transition to telemedicine, researchers reported late last week in Open Forum Infectious Diseases.

In the study, researchers from Stanford University School of Medicine compared the proportion of clinic and telemedicine visits at two academic urgent care clinics during which antibiotics were prescribed before (December to January 2019) and during (January to December 2020) the pandemic. They extracted diagnoses and antibiotic data from the electronic medical record and assigned each encounter a disease category and an antibiotic prescribing tier based on whether antibiotics were almost always (tier 1), sometimes (tier 2), or almost never (tier 3) indicated.

A total of 69,842 encounters were analyzed, with 33,591 occurring before and 36,251 during COVID-19. Telemedicine visits rapidly increased in March 2020 and became the dominant visit modality thereafter. The pre-COVID-19 antibiotic prescribing rate was 17%, compared with 11% during COVID-19. The antibiotic prescribing rate was 9% in telemedicine and 15% in clinic visits during COVID-19. The overall decline in antibiotic prescribing was driven primarily by encounters for a respiratory diagnosis and was not observed in encounters for gastrointestinal, genitourinary, skin, or other infections.

Among respiratory encounters, antibiotics were prescribed less frequently across all tiers during COVID-19: tier 1 (63% vs 56%), tier 2 (37% vs 27%), and tier 3 (16% vs 5%). Less than 1% of COVID-19 encounters were associated with an antibiotic prescription.

The study authors say the reasons for the decline likely include changes in healthcare use, local epidemiology, and the impact of local masking and physical distancing measures on common respiratory pathogen transmission.

"Future studies are needed to investigate these factors with a goal of promoting optimal antibiotic prescribing for all viral respiratory conditions," they wrote. "The big question remains as to whether the lower antibiotic prescribing rates will be sustained beyond the COVID-19 pandemic."
Jan 22 Open Forum Infect Dis abstract

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