Antimicrobial Stewardship & Healthcare Epidemiology最新文献

{"title":"Oregon Project Firstline: A needs assessment of healthcare personnel infection prevention knowledge and training preferences","authors":"Nicholas Ida, Judith Guzman-Cottrill, Roza Tammer, Rebecca Pierce, Dat Tran","doi":"10.1017/ash.2023.348","DOIUrl":"https://doi.org/10.1017/ash.2023.348","url":null,"abstract":"Background: Infection prevention and control (IPC) competency is critical for healthcare personnel (HCP) and patient safety. In collaboration with the CDC new national IPC training collaborative called Project Firstline, the Oregon Health Authority’s (OHA) Healthcare Associated Infection (HAI) Program established a state-level program in 2021. The goal of Oregon Project Firstline is to provide relevant, accessible, and engaging IPC training materials for our state’s HCP. We assessed the IPC learning needs of Oregon’s healthcare workforce, and to understand the preferred methods and formats of training across the various HCP roles. Methods: OHA’s HAI program recruited HCP by distributing electronic surveys through multiple healthcare, regulatory, and public health partners’ email listservs and HCP-targeted newsletters. Survey responses were recorded from September 23 to December 10, 2021. The HAI program assessed respondents’ IPC knowledge, online and in-person job training preferences, frequently used training devices, and trusted sources for IPC information. An individual’s understanding of an IPC topic was categorized based on their self-assessed confidence in their knowledge and ability to teach the topic to others. In total, 6,382 surveyed responses were analyzed. Results: The average understanding among HCP was lowest in IPC topics relating to triage and isolation of contagious patients and fit testing of respiratory protection devices. For these topics, 3,208 HCP (66.21%) and 3,657 HCP (75.48%) HCP, respectively, did not understand the topic well enough to teach others (Fig. 1). The highest number of HCP (n = 2,512, 39.36%) requested additional training in methods on how to educate others about IPC topics (ie, “train the trainer”). Surveyed respondents most frequently used personal computers for job trainings in both work and at-home settings (n = 4,603, 72.12%) and 3,437 HCP (53.85%) were open to either in-person or remote formats for job education. The CDC and OHA were the most frequented and trusted IPC sources among surveyed HCP: 4,124 HCP (64.62%) and 3,584 HCP (56.16%), respectively. Conclusions: IPC is a critical topic in HCP training across all healthcare facility types and employee roles. Effective educational planning includes understanding the learners’ knowledge needs and preferred methods of learning. Our learning needs assessment identified important IPC knowledge gaps and will help ensure that our training courses will be offered in effective educational formats for Oregon’s diverse HCP. Future training will include appropriate triage of potentially infectious patients, respiratory fit testing, and general IPC “train the trainer” sessions. Additionally, we will offer both in-person and remote options. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135145146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and duration of antibacterial drug supply chain issues in the United States, January 2017–June 2022","authors":"Katie Suda, Katherine Callaway Kim, Inma Hernandez, Mina Tadrous","doi":"10.1017/ash.2023.382","DOIUrl":"https://doi.org/10.1017/ash.2023.382","url":null,"abstract":"Background: Drug manufacturing and distribution is a complex, global process. The global drug supply chain is prone to disruptions associated with geopolitical issues, trade, civil unrest, severe weather, and pandemics, all of which have the potential to affect medication supply and result in drug shortages. To our knowledge, the extent to which the supply of antimicrobials is threated due to disruptions in the drug supply chain in the United States is unknown. We examined trends and duration of disruptions to the drug supply chain for antimicrobials. Methods: Manufacturer reports of supply disruptions were extracted from the Food and Drug Administration (FDA) and the American Society for Health-Systems Pharmacists (ASHP) websites and merged on the agent-formulation level. For each month of the study period, a drug was considered to have an active supply chain issue if an FDA or ASHP shortage or recall report overlapped with that month for ≥15 days, or if a discontinuation had occurred within the previous 3 months. Total months of supply chain issues were summed for antimicrobials overall, at the agent formulation , and class levels. A Mann-Kendall test was used to determine the significance of trends in supply-chain issues. Results: Of 105 antimicrobials purchased in the United States, 74 (70%) had a supply-chain issue for ≥1 month from January 15, 2017, to June 30, 2022. Combined, the 74 agents had 1,611 total months of supply-chain issues over the 66-month study period. Agents from the penicillin class were most frequently affected (ie, 80% of penicillins had supply-chain issues for 206 months), but cephalosporins had supply-chain issues for the longest duration (66% of cephalosporins for 653 months). From 2017–2021, supply-chain issues decreased significantly for penicillins and quinolones (tests of trend, P = .01 and .02, respectively). No trend was identified for the other classes or antimicrobials overall. Interestingly, supply-chain issues for most classes did not increase with seasonal increases in antimicrobial use. Also, supply-chain issues affected 33 antimicrobial agents for at least half of the study period, and supply-chain issues affected ampicillin-sulbactam, cefotaxime, ceftazidime, cefotetan, cefepime, clindamycin, vancomycin for 100% of the study period. Conclusions: Drug supply-chain issues commonly affect antimicrobials and are not improving for most classes. Drug supply-chain issues cause significant strain on healthcare, including drug procurement, access to optimal therapy, and poses challenges to prescribing and antimicrobial stewardship. To decrease the threat to the antibacterial drug supply, action should be taken to strengthen the drug supply chain to ensure access to these essential medicines. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient parenteral antimicrobial therapy (OPAT) in a safety-net hospital: Opportunities for improvement","authors":"Rory Bouzigard, Mark Arnold, Jacob Player, Norman Mang, Michael Lane, Trish Perl, Laila Castellino","doi":"10.1017/ash.2023.364","DOIUrl":"https://doi.org/10.1017/ash.2023.364","url":null,"abstract":"Background: Parkland Health is a 900-bed safety-net hospital that serves Dallas County, Texas. It has an OPAT program in which patients are managed via self-administration (S-OPAT), home-health/hemodialysis (H-OPAT), and skilled nursing facilities (SNF-OPAT). We evaluated the reasons for unscheduled emergency department (ED) visits by patients in these groups to identify strategies to decrease unexpected healthcare utilization and to improve safety. Methods: We performed a retrospective chart review of all adult patients discharged from Parkland Health on OPAT between April and June 2021. Demographic, medical, and healthcare utilization information, including the date and reason of first unscheduled ED visit after discharge, was collected utilizing a standardized instrument. The institutional review board approved this study. Results: In total, 184 patients were discharged with OPAT. Among them, 32% were female and 55% identified as Hispanic; 41% were non-English speakers, and 45% were treated for a musculoskeletal infection. Among all OPAT models of care, 43.4% were S-OPAT patients, 31.5% were H-OPAT patients, and 25% were SNF-OPAT patients (Table 1). The groups differed, and fewer African Americans received H-OPAT. Also, 45% were being treated for musculoskeletal infections and were more likely to be discharged with H- or SNF-OPAT. In addition, 41% were being treated for endovascular infections and 21.7% were being treated for genitourinary infections. The total length of stay in the hospital was longer for SNF-OPAT patients and shorter for S-OPAT patients (Table 2). Among 184 OPAT patients, 41 patients (22.2%) had an ED visit: 17.3% SNF-OPAT patients, 27.6% H-OPAT patients, and 21.3% S-OPAT patients (Table 2). ED visits were attributed to intravenous (IV) access–related problems (12 of 41, 29.0%), worsening of known infection (3 of 41, 7.3%), and abnormal blood test results (2 of 41, 4.9%). Also, 24 ED visits (58%) were not related to underlying infection or OPAT. However, when examined by the OPAT care model, 41% of ED visits among S-OPAT patients, 20% among H-OPAT visits, and 25% among SNF-OPAT visits were related to IV access issues. Among S-OPAT ED visits pertaining to IV access, 71% were for minor issues such as dressing changes or line occlusion or malfunction. Conclusions: One-fifth of OPAT patients had an unscheduled ED visit, of whom 20%–41% had issues with IV access. Many of these visits could be avoided with enhanced outreach to patients discharged with OPAT and improved ambulatory capabilities to provide standard services related to maintenance of IV access. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare worker perceptions about infection prevention and control processes and practices in Latin America","authors":"Valeria Fabre, Pilar Beccar-Varela, Carolyn Herzig, Guadalupe Reyes-Morales, Clare Rock, Rodolfo Quiros","doi":"10.1017/ash.2023.327","DOIUrl":"https://doi.org/10.1017/ash.2023.327","url":null,"abstract":"Background: The burden of hospital-associated infections (HAIs) and antimicrobial resistance (AMR) in Latin America is high. Improving engagement by healthcare workers (HCWs) in infection prevention and control (IPC) may lead to better patient outcomes; however, little is known about HCW perceptions of IPC in the region. We sought to understand HCW perceptions of IPC processes and practices. Methods: During August–September 2022, HCWs from 30 hospitals with IPC programs in 4 Latin American countries (Panama, Guatemala, Ecuador, and Argentina) were invited to participate in an electronic, voluntary, anonymous survey about their perceptions of IPC at their hospitals. Physicians, nurses, and environmental care (EVC) personnel were prioritized for recruitment. All respondents were asked 18 questions; IPC team members were asked 5 additional questions about specific activities implemented by IPC programs, how data are used, and how IPC could be improved. Answers with 5-point Likert scale responses were categorized into 2 groups (eg, strongly agree or agree vs neutral, disagree, or strongly disagree) for analysis. Results: Of 1,252 HCWs who completed the survey, 181 (14%) were IPC team members, 1,095 (87%) had direct patient contact, and 1,156 (92%) worked >20 hours per week. Figure 1 shows participant characteristics. Most participants (56%) rated their IPC program as very good, 38% rated it as good, and 6% rated it as bad. Physicians were less likely to give a favorable rating. Compliance with prevention bundles and hand hygiene (HH) by colleagues was rated as poor by 28% and 22% of HCWs, respectively; however, only 11% and 5% indicated that their own compliance was poor, respectively. Also, 25% of participants reported not receiving or only occasionally receiving HH compliance data. Similarly, 41% of participants reported not receiving HAI data on a regular basis, and 19% of IPC nurses reported not receiving data despite being responsible for conducting surveillance. Furthermore, 41% of respondents indicated not receiving or only occasionally receiving IPC training or education relevant to their role. When asked about the safety climate, 16% of participants reported not feeling appreciated. In addition, 22% of IPC nurses and 37% of individuals in the “other” category (eg, health technicians and therapists) were more likely to report this. When IPC team members were asked how frequently specific activities were conducted (Fig. 2), several opportunities for improvement were identified, including improving HCW access to HH data and development of strategic plans. Conclusions: Improving HCW access to training on IPC and to data on HAI burden and compliance with HH and prevention bundles should be emphasized in Latin American hospitals. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the efficacy of routine disinfection methods on frequently used physical therapy equipment","authors":"Aaron Barrett, Amanda Graves, Elaine De Jesus, Jennifer Edelschick, Diandrea McCotter, Deverick Anderson, Nicholas Turner, Bobby Warren","doi":"10.1017/ash.2023.311","DOIUrl":"https://doi.org/10.1017/ash.2023.311","url":null,"abstract":"Background: Frequently used physical therapy (PT) equipment is notably difficult to disinfect due to equipment material and shape, however, the efficacy of standard disinfection of PT equipment is poorly understood. Methods: We completed a prospective observational microbiological analysis of fomites used in adult or pediatric PT at Duke University Health System, Durham, North Carolina, from September to December 2022. Predetermined study fomites were obtained after being used during a clinical shift and standard disinfection had been completed by clinical service staff. Fomites were split into 2 halves, left and right, for sampling. Samples were taken with premoistened cellulose sponges processed using the stomacher technique and were incubated on appropriate selective and general medias. We defined antimicrobial-resistant, clinically important pathogens (AMR-CIP) as MRSA, VRE, and MDR-gram-negative isolates, and non–AMR-CIP as MSSA, VSE, and gram-negative species. Study fomites were grouped as follows: (1) pediatric pig toy, (2) walking aids (walkers or canes), (3) balls (medicine, dodge, etc), and (4) other (foam roller, sliding board, etc). Results: In total, 47 patients, 61 fomites, and 122 were analyzed. Of the study patients, 24 (51%) were female, 13 (27%) had active infections, and 15 (32%) were on contact precautions. Because fomites were split in half, patients in the left and right study arms were identical. Overall, the median total colony-forming-units (CFU) of study fomites was 1,348 (IQR, 398–2,365): 468 (IQR, 161–1,230) for the left side study arm and 540 (IQR, 102–1,221) for the right study arm ( P = .45). At the sample level, 52 (43%), 15 (12%), and 37 (30%) of 122 samples harbored any CIPs, AMR CIPs, or non-AMR CIPs, respectively. At the fomite level, 27 (44%), 5 (8%), 15(25%), and 7 (11%) of 61 fomites harbored any CIPs, only AMR-CIPs, only non-AMR CIPs, or both AMR and non-AMR CIPs, respectively. Generally, therapy balls were the most contaminated study fomites (n = 2,237; IQR, 1,425–2,658), and walking aids were most frequently contaminated with any CIPs (n = 26, 72%), AMR CIPs (n = 8, 22%), and non-AMR CIPs (n = 15, 47%). Discussion: Following routine disinfection, frequently used PT equipment remained heavily contaminated and harbored AMR and non-AMR CIPs, supporting the notion that PT equipment is difficult to disinfect via standard disinfection. Additionally, left-, and right-side fomite divisions had similar pathogens, suggesting that this sampling model of intrapatient comparisons may be helpful for resolving case-mix issues in future studies. Future work should focus on PT-specific enhanced disinfection strategies to improve the disinfection of PT equipment. Financial support: This study was funded by PURioLABS. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children","authors":"Kathleen Chiotos, Robert Grundmeier, Didien Meyahnwi, Lauren Dutcher, Ebbing Lautenbach, Melinda Neuhauser, Keith Hamilton, Anne Jaskowiak, Leigh Cressman, Julia Szymczak, Brandi Muller, Jeffrey Gerbe","doi":"10.1017/ash.2023.381","DOIUrl":"https://doi.org/10.1017/ash.2023.381","url":null,"abstract":"Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic use in hospitalized children and is a key target for pediatric antimicrobial stewardship programs (ASPs). Building upon prior work, we developed and refined an electronic algorithm to identify children hospitalized with CAP and to evaluate the appropriateness of initial antibiotic choice and duration. Methods: We performed a cross-sectional study including children 6 months to 17 years hospitalized for CAP between January 1, 2019, and October 31, 2022, at a tertiary-care children’s hospital. CAP was defined electronically as an International Classification of Disease, Tenth Revision (ICD-10) code for pneumonia, a chest radiograph or chest computed tomography scan (CT) performed within 48 hours of admission, and systemic antibiotics administered within the first 48 hours of hospitalization and continued for at least 2 days. We applied the following exclusion criteria: patients transferred from another healthcare setting, those who died within 48 hours of hospitalization, children with complex chronic conditions, and those with intensive care unit stays >48 hours. Criteria for appropriate antibiotic choice and duration were defined based on established guidelines. Two physicians performed independent medical record reviews of 80 randomly selected patients (10% sample) to evaluate the performance of the electronic algorithm in (1) identifying patients treated for clinician-diagnosed CAP and (2) classifying antibiotic choice and duration as appropriate. A third physician resolved discrepancies. The electronic algorithm was compared to this medical record review, which served as the reference standard. Results: Of 80 children identified by the electronic algorithm, 79 (99%) were diagnosed with CAP based on medical record review. Antibiotic use was classified as the appropriate choice in 75 (94%) of 80 cases, and appropriate duration in 16 (20%) of 80 cases. The sensitivity of the electronic algorithm for identifying appropriate initial antibiotic choice was 94%; specificity could not be calculated because no events of inappropriate antibiotic choice were identified based on chart review. The sensitivity and specificity for determining appropriate duration were 88% and 97%, respectively (Table 1). Conclusions: The electronic algorithm accurately identified children hospitalized with CAP and demonstrated acceptable performance for identifying appropriate antibiotic choice and duration. Use of this electronic algorithm may improve the efficiency of stewardship activities and could facilitate alignment with updated accreditation standards. Future studies validating this algorithm at other centers are needed. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between stopping universal SARS-CoV-2 admission testing and hospital-onset SARS-CoV-2 in England and Scotland","authors":"Theodore Pak, Chanu Rhee, Michael Klompasl","doi":"10.1017/ash.2023.391","DOIUrl":"https://doi.org/10.1017/ash.2023.391","url":null,"abstract":"Background: Many hospitals test all patients for SARS-CoV-2 upon admission to prevent silent transmission to other patients and healthcare workers. The utility of universal admission testing has been questioned, however, due to resource constraints, care delays, and sparse data on its impact on nosocomial infections. England and Scotland stopped requiring universal admission testing on August 31, 2022, and September 28, 2022, respectively. We assessed associations between these changes and hospital-onset SARS-CoV-2 infection rates. Methods: We used public data from National Health Service England and Public Health Scotland on hospital-onset SARS-CoV-2 infections, defined as cases diagnosed >7 days after admission, between July 1, 2021, and December 16, 2022. Because hospital-onset infections are driven by SARS-CoV-2 community incidence rates, we calculated the weekly ratio between hospital-onset versus community-onset SARS-CoV-2 admissions (diagnosed ≤7 days from admission) and assessed for temporal changes associated with stopping universal admission testing using interrupted time-series analysis. The study was divided into 3 periods: sARS-CoV-2 delta-variant dominance with admission testing, SARS-CoV-2 omicron-variant dominance with admission testing (starting December 14, 2021), and SARS-CoV-2 omicron-variant dominance without admission testing. Results: During the study period, there were 518,379 COVID-19 admissions in England, including 398,264 community-onset and 120,115 hospital-onset cases, and 46,517 COVID-19 admissions in Scotland, including 34,183 community-onset and 12,334 hospital-onset cases. The mean weekly ratio of new hospital-onset SARS-CoV-2 infections versus community-onset admissions in England rose from 0.12 during the SARS-CoV-2 delta-variant surge to 0.33 during the SARS-CoV-2 omicron-variant surge to 0.48 after universal admission testing ended (Fig.). There was a significant immediate level change both after the SARS-CoV-2 delta-to-omicron variant transition (92% relative increase; 95% CI, 58%–127%) and after admission testing ended (32% relative increase; 95% CI, 14%–50%). Likewise, the mean weekly ratios rose from 0.11 to 0.43 to 0.89 during their analogous periods in Scotland, with significant level changes both after SARS-CoV-2 delta-to-omicron variant transition (113% relative increase; 95% CI, 54%–172%) and after admission testing ended (72% relative increase; 95% CI, 43%–100%). No significant trend changes were observed. Conclusions: Stopping asymptomatic screening of hospitalized patients in 2 national health systems was associated with significant increases in hospital-onset SARS-CoV-2 infections. Nosocomial SARS-CoV-2 remains a common and potentially morbid complication, with reported mortality rates for nosocomial infections by SARS-CoV-2 omicron variant ranging from 5% to 13%. Preventing infections in vulnerable populations remains an important safety goal. Hospitals should exercise caution when considerin","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic phenotyping of community-acquired pneumonia: A tool for inpatient syndrome-specific antimicrobial stewardship","authors":"Amy Chang, Annie Bui, David Ha, William Alegria, Marisa Holubar, Brian Lu, Leah Mische, Rebecca Linfield, Kyle Walding, Emily Mui","doi":"10.1017/ash.2023.394","DOIUrl":"https://doi.org/10.1017/ash.2023.394","url":null,"abstract":"Background: Using patient data from the electronic health record (EHR) and computer logic, an “electronic phenotype” can be created to identify patients with community-acquired pneumonia (CAP) in real time to assist with syndrome-specific antimicrobial stewardship efforts. 1 We adapted and validated the performance of an inpatient CAP electronic phenotype for antimicrobial stewardship interventions. Methods: An automated scoring system was created within the EHR (Epic Systems) to identify hospitalized patients with CAP based on the variables and logic listed in Fig. 1B. We adapted a score used by the Michigan Hospital Medicine Safety Consortium (HMS) to identify patients with CAP, with additions made to improve sensitivity (Fig. 1). 1 The score can be displayed in a column within the EHR patient list (Fig. 2). We validated the electronic phenotype via chart review of all hospitalized patients on systemic antimicrobials admitted to a medicine team consecutively between November 8 and 18, 2021. Patients who were readmitted within the validation time frame were excluded. We assessed the performance of the electronic phenotype by comparing the score to manual chart review, where “CAP diagnosis” was defined as (1) mention of “pneumonia” or “CAP” as part of the differential diagnosis in the admission documentation, (2) antimicrobials were started within 48 hours of admission, and (3) radiographic findings were suggestive of pneumonia. After initial evaluation, the scoring system was adjusted, and performance was re-evaluated during prospective audit and feedback performed on EHR CAP–positive patients over 13 days between July 2022 and December 2022. Results: We included 191 patients in our initial validation cohort. The CAP score had high sensitivity (95.83%), specificity (92.2%), and negative predictive value (99.35%), though lower positive predictive value (63.89%) was noted (Table 2). The rules were further refined to include bloodstream infection only with Haemophilus influenza or Streptococcus pneumoniae in rule 2B, and azithromycin was removed from “CAP antibiotics.” After these changes, repeated evaluation of 88 patients with positive CAP EHR score was performed, and only 20 (23%) were considered false-positive results. Conclusions: Electronic phenotypes can be used to create automated tools to identify patients with CAP with reasonable performance. Data from this tool can be used to guide more focused antimicrobial stewardship interventions and clinical decision support in the future. Reference: Vaughn VM, et al. A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia. Clin Infect Dis 2022;75:460–467. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of indication in a urinalysis driven reflex urine culture protocol at an academic medical center","authors":"Mackenzie Keintz, Jasmine Marcelin, Mark Rupp, Trevor Van Schooneveld","doi":"10.1017/ash.2023.306","DOIUrl":"https://doi.org/10.1017/ash.2023.306","url":null,"abstract":"Background: Asymptomatic bacteriuria (ASB) is a widespread problem in hospitalized patients in which only a small subset of patients benefit from treatment. Other patient populations with ASB are harmed by treatment. In 2014, our institution implemented a urinalysis (UA)-driven reflex culture protocol which evaluated patient symptoms, risk factors, and the UA to determine whether bacterial culture was performed (Fig. 1). The goal of this process was to ensure that urine cultures were only performed in those patients who had symptoms of UTI and an abnormal urinalysis while allowing for exceptions in populations where treatment of ASB may be appropriate (ie, pregnancy, aged <3 years, impending urologic surgery, kidney transplant) or where the urinalysis may not be useful in determining whether infection is present (ie, neutropenia). An “other” indication with free-text documentation required was included to allow for unique situations. We evaluated the free-text option to determine whether additional indications were needed and whether data entered were medically appropriate. Methods: This retrospective review at a Midwestern, tertiary-care, academic medical center included inpatient UA with UTI evaluation order sets between July 1, 2020, and June 30, 2022. Descriptive statistics analyzed order-set utilization. Results: In total, 35,469 “urinalysis to reflex culture” order sets were submitted, of which 9,493 resulted in culture. Of these, 839 (8.8%) were ordered with an indication of “other.” “Other” was the most cited indication for special population override contributing to 40% (n = 839 of 2,085) of these indications, followed by kidney or pancreas transplant (29%) and neutropenia (13%). The write-in options fell into 1 of 11 themes (Fig. 2). The 3 most common reasons a urine culture was obtained using the free-text option were nonurologic surgical intervention (n = 223 of 839), immunosuppression not otherwise defined (n = 195 of 839), and symptom presence (n = 146 of 839). Based on current literature, 97% of other indications were inappropriate (n = 816 of 839). If the UTI protocol had been strictly followed, 696 of 839 (83%) cultures ordered with an indication of “other” would not have been obtained, due either to lack of symptoms or, if symptomatic, lack of pyuria. Conclusions: Most cultures obtained by selecting the “other” special population option on the algorithm were obtained in situations in which a urine culture was unnecessary. Removing the “other” indication from the algorithm may improve appropriateness of urine culturing with a possible decrease in CA-UTI and treatment of ASB. Although most write in rationales were inappropriate, adding an additional category for deceased donor-organ evaluation would be reasonable. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare-associated <i>Stenotrophomonas maltophilia</i> infections in the United States, 2018–2022","authors":"Amelia Keaton, Lucy Fike, Kevin Spicer, Alexander Kallen, Kiran Perkins","doi":"10.1017/ash.2023.352","DOIUrl":"https://doi.org/10.1017/ash.2023.352","url":null,"abstract":"Background: Stenotrophomonas maltophilia is an important cause of opportunistic healthcare-associated infections (HAIs) in critically ill patients and is difficult to treat due to intrinsic resistance to multiple antibiotic classes. During the COVID-19 pandemic, the CDC received anecdotal reports of increases in S. maltophilia respiratory infections. To further investigate these reports, we used a national electronic healthcare database to evaluate changes in S. maltophilia during the pandemic. Methods: Using the PINC-AI healthcare data (Premier Inc, Charlotte, NC) we identified all potential HAIs by calculating the total number of unique patients hospitalized during January 1, 2018, through December 31, 2021, who had any organism isolated on clinical culture obtained &gt;3 days after admission. We calculated the proportion of patients with S. maltophilia detected in culture and stratified them by specimen source. To determine whether COVID-19 diagnosis influenced the proportion of patients diagnosed with S. maltophilia respiratory infections during the pandemic (January 1, 2020–December 31, 2021), we calculated the proportion of patients with S. maltophilia detected among those with any bacterial pathogen isolated from a respiratory culture &gt;3 days after hospitalization. We stratified these results by presence or absence of concurrent COVID-19 diagnosis. Pearson χ 2 test was used to test for differences where appropriate. Results: Among hospitalized patients with any organism isolated from a clinical culture, the proportion with S. maltophilia detected was higher in 2021 (n = 2,554 of 118,029, 2.2%) than in 2018 (n = 2,063 of 155,624, 1.3%) p 3 days after hospital admission from 2018 to 2021. Most patient isolates were from respiratory specimens. A concurrent diagnosis of COVID-19 did not appear to increase the likelihood of respiratory S. maltophilia detection. The increases in S. maltophilia during the pandemic might be explained by challenges inherent to caring for increased numbers of higher-acuity patients during this time, including staffing shortages and changes to infection prevention practices. Additional exploration of these data, as well as data from other sources and from additional years, may help to elucidate this issue more fully. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}