US stewardship effort tied to lower antibiotics in ambulatory care during COVID
A national ambulatory antibiotic stewardship program was associated with declines in overall and acute respiratory infection (ARI)-related prescribing during the COVID-19 pandemic, US researchers reported last week at ID Week 2021.
Out of 467 ambulatory practices enrolled, 389 completed the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use, a program that aims to incorporate antibiotic stewardship into practice culture, communication, and decision-making through education and technical support. The program uses webinars, audio presentations, educational tools, and office hours to address attitudes and culture that pose challenges to judicious antibiotic prescribing and to incorporate best practices for managing common infections into clinician workflow.
To evaluate the program's effectiveness, researchers compared total visits to the practices, visits for ARI, and antibiotic prescribing in the pre-intervention (September to November 2019) and intervention (December 2019 to November 2020) periods.
The 389 practices included 162 primary care practices, 160 urgent care clinics, and 49 federally supported practices. Visits per practice-month declined from March to May 2020 but gradually returned to baseline by program end.
Total antibiotic prescribing declined by 9 prescriptions per 100 visits (95% confidence interval [CI], -10 to -8). ARI visits/practice-month declined significantly from March to May 2020, then increased but remained below baseline by program end. ARI-related antibiotic prescriptions decreased by 15/100 ARI visits by program end (95% CI, -17 to -12). The greatest reduction was in penicillin class prescriptions, with a reduction of 7/100 ARI visits by program end (95% CI, -9 to -6).
"We have demonstrated that it is possible to implement stewardship on a large scale in different practices and settings across the country,” Sara Keller, MD, MPH, associate professor at Johns Hopkins University School of Medicine and the study's presenting author, said in an ID Week press release. "To improve antibiotic use is to improve patient safety. There is immense hope in that."
Sep 30 IDWeek press release
Leafy greens outbreaks part of this season's Cyclospora cases
In an annual final update on domestically acquired Cyclospora cases, which typically increase in warm weather months, the US Centers for Disease Control and Prevention (CDC) said 1,020 cases from 36 states were reported, with 170 linked to two large multistate outbreaks associated with restaurants or events.
One multistate outbreak involved 40 illnesses and the other resulted in 130 infections. For both, traceback investigations suggested leafy greens, but no specific grower or type of greens were identified. In the past, Cyclospora outbreaks were tied to various produce items, including basil, cilantro, mesclun lettuce, and snow peas. In 2020, multiple outbreaks were reported and involved various produce items, including bagged salad mix.
The CDC's tally of this year's cases shows that 70 people were hospitalized, with no deaths reported. The latest illness onset was Aug 31.
Cases this year were below the 1,241 cases reported over the same time period in 2020. Infections are caused by the parasite Cyclospora cayetanensis, which can be found in food or drinking water contaminated with feces. Symptoms of cyclosporiasis include profuse diarrhea that can last weeks to months.
Sep 30 CDC final outbreak update