Multimodal stewardship intervention linked to fewer outpatient antibiotics
A multimodal intervention at primary care practices in a large healthcare system in North Carolina was associated with significant decreases in inappropriate outpatient antibiotic prescribing for upper respiratory tract infections, researchers reported today in Infection Control & Hospital Epidemiology.
The interventions included in the Carolinas Healthcare Outpatient Antimicrobial Stewardship Outpatient Network (CHOSEN) included an antimicrobial stewardship health education campaign for patients and providers, and an interactive reporting dashboard for comparing antibiotic prescribing among providers, practices, and organizational groupings. In the study, researchers evaluated the impact of the initiative before (April 2016 to October 2017) and after (May 2018 to March 2020) it was implanted at 162 ambulatory family medicine, internal medicine, pediatric medicine, and urgent care facilities. The primary outcome of interest was inappropriate antibiotic prescribing for upper respiratory infections by primary-care service line.
Overall, the proportion of encounters with antibiotics inappropriately prescribed fell from 47.5% in the pre-intervention period (286,580 antibiotic prescriptions in 404,248 encounters) to 38.7% during the intervention period (277,177 prescriptions in 832,200 encounters). The relative difference in prescribing rates was –18.5%. Comparison of monthly antibiotic prescribing rates showed that after CHOSEN was implemented, encounters in family medicine showed the largest relative decrease in the proportion of visits with inappropriate antibiotic prescribing (–20.4%), followed by internal medicine (–19.5%), pediatric medicine (–17.2%), and urgent care (–16.6%).
The study authors say the key factors in the success of the CHOSEN intervention included diverse stakeholder engagement in design and implementation, unified messaging and tools across all service lines and practices, senior leadership support, and timely performance feedback and data transparency. The intervention has since been expanded to the emergency division, school-based care practices, and virtual visits.
"Detailed evaluations of changes in prescribing by indications, provider characteristics, practice type, and antibiotic classes, along with their interactions, are planned for future analysis," they wrote.
May 2 Infect Control Hosp Epidemiol study
Follow-up blood cultures tied to longer hospital stays, antibiotic duration
In a study published late last week in the same journal, researchers found that follow-up blood culture (FUBC) practices for gram-negative bacilli (GNB) bacteremia were associated with prolonged length of hospital stay and duration of antibiotic treatment.
To evaluate the value of routine FUBC for GNB bacteremia, which has been questioned because of the increased risk of false-positive results, researchers conducted a retrospective observational study at four acute-care hospitals in New York City, comparing length of hospital stay, antibiotic duration, and in-hospital mortality in patients with GNB bacteremia who had FUBCs performed and those who didn't. Of the 376 hospitalized patients with GNB bacteremia who met eligibility, 271 (72%) had FUBCs performed.
After propensity score matching, the researcher analyzed 87 pairs of patients with and without FUBCs. The median length of stay was longer among patients with FUBCs than patients without FUBCs (9 days vs 7 days; P = .017). The median duration of antibiotic treatment was also longer among patients with FUBCs than patients without (8 vs 6 days; P = .007). No statistically significant difference was observed in in-hospital mortality between patients with and without an FUBC (odds ratio, 0.37; 95% confidence interval [CI], 0.08 to 1.36).
"In conclusion, current clinical practices of obtaining FUBCs in patients with GNB bacteremia may be associated with prolonged length of stay and duration of in-hospital antimicrobial therapy," the study authors wrote. "Thus, the development of validated selection criteria for identifying subgroups in which FUBCs are likely to have a higher or lower yield is essential to optimizing clinical outcomes and resource utilization."
Apr 29 Infect Control Hosp Epidemiol study