Stewardship / Resistance Scan for Aug 15, 2022

Improved prescribing for respiratory infections
Dental antibiotic stewardship

VHA program tied to improved antibiotic use for respiratory infections

A clinician-directed intervention implemented at facilities in the Veterans' Healthcare Administration (VHA) was associated with better management of, and reduced antibiotic prescribing for, acute respiratory infections (ARIs), researchers reported today in Infection Control & Hospital Epidemiology.

The ARI Campaign, implemented in 2017 by the VHA's Antimicrobial Stewardship Taskforce to reduce unnecessary antibiotic prescribing for ARIs, encourages Veterans' Affairs (VA) hospitals to engage high-prescribing physicians with two strategies: audit and feedback with peer comparison of ARI antibiotic prescribing rates, and individualized academic detailing of ARI management. To evaluate the effectiveness of the ARI Campaign, researchers with the VA and the Centers for Disease Control and Prevention (CDC) calculated the probability of receiving antibiotics for an ARI before and after implementation (October 2012 through March 2019). Secondary outcomes included probability of a return clinic visit or infection-related hospitalization.

Comparing 1,003,509 and 323,023 uncomplicated ARI visits before and after implementation, respectively, the researchers found the probability of receiving antibiotics for ARI decreased 18% after implementation (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.78 to 0.86). Facilities with the highest quartile of intervention intensity demonstrated larger reductions in antibiotic prescribing (OR, 0.69; 95% CI, 0.59 to 0.80) compared to nonparticipating facilities (OR, 0.89; 95% CI, 0.73 to 1.09).

Return visits (OR, 1.00; 95% CI, 0.94 to 1.07) and infection-related hospitalizations (OR, 1.21; 95% CI, 0.92 to 1.59) were not different before and after implementation within facilities that performed intensive implementation.

"The findings suggest that implementation of the clinician-directed intervention was associated with improvements in guideline-concordant ARI management," the study authors concluded.
Aug 15 Infect Control Hosp Epidemiol abstract


Antibiotic stewardship education linked to improved dental antibiotic use

The first US antibiotic stewardship intervention for private practice dentists was associated with fewer antibiotic prescriptions and significant improvements in appropriate antibiotic prescribing, researchers reported last month in Open Forum Infectious Diseases.

In a prospective multipractice cohort study, a team led by Ohio State pharmacists and clinicians recruited private practice dentists for a four-phase dental antibiotic stewardship initiative. The four phases included collection of baseline antibiotic use data and a pre-education survey to establish the level of knowledge about antibiotic stewardship, three interactive education sessions conducted by infectious disease and antibiotic stewardship program (ID ASP) experts, 3 months of audit and weekly feedback with 1-on-1 consults for dentists who prescribed antibiotics inappropriately, and a post-education survey.

Outcomes assessed included overall antibiotic prescribing, antibiotic appropriateness, and antibiotic duration before and after education.

Fifteen dentists participated, 10 of whom had practiced for more than 20 years. The pre-education survey found 14 were unfamiliar with dental antibiotic stewardship. While procedures over the study period increased from 8,526 to 9,203, the number of antibiotic prescriptions pre/post-education decreased 14.5%, from 2,124 to 1,816. Overall, the proportion of appropriate antibiotic use (both for treatment and prevention) increased from 19% to 87.9% pre/post-education, with appropriate prophylactic antibiotic use improving from 46.6% to 76.6% and appropriate use of treatment antibiotics improving from 15% to 90.2%.

In addition, antibiotic duration pre/post-education decreased from 7.7 days to 5.1 days, and use of clindamycin declined 90%. The post-education survey responses recommended making antibiotic stewardship a required annual continuing education component.

"Similar to antibiotic stewardship in hospitals, simply asking physicians or dentists to do a better job at prescribing antibiotics does not work," the study authors wrote. "After learning dental antibiotic stewardship from ID ASP experts, dentists rapidly optimized antibiotic use."

The authors also note that they have since been invited to speak about dental antibiotic stewardship at local and national study clubs and dental societies.
Jul 25 Open Forum Infect Dis study

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