A real-time AS intervention implemented alongside introduction of the Verigene BC-GP assay led to improvements in antibiotic therapy for patients with bacteraemia due to Gram-positive cocci, even after the AS intervention was discontinued.

Background: Literature suggests that antibiotic prescribing in COVID-19 patients is high. Currently, there are insufficient data on what drives antibiotic prescribing practices throughout the COVID-19 pandemic. Objective: This study sought to determine antibiotic use rates and identify risk factors for antibiotic prescribing in hospitalized patients. It was the first study to assess risk factors for receiving more than 1 course of antibiotics. Methods: This was a retrospective, multi-center, observational study. Patients admitted from March 1, 2020, to May 31, 2020, and treated for COVID-19 were included. The primary endpoint was the rate of antibiotic use during hospitalization. Secondary endpoints included risk factors associated with antibiotic use, risk factors associated with receiving more than 1 antibiotic course, and rate of microbiologically confirmed infections. Results: A total of 208 encounters (198 patients) were included in the final analysis. Eighty-three percent of patients received at least 1 course of antibiotics, despite low rates of microbiologically confirmed infection (12%). Almost one-third of patients (30%) received more than 1 course of antibiotics. Risk factors identified for both antibiotic prescribing and receiving more than 1 course of antibiotics included increased hospital length of stay (median 12 days), intensive care unit admission, and the necessity for mechanical ventilation. Conclusion and Relevance: There were high rates of antibiotic prescribing with low rates of microbiologically confirmed bacterial co-infection. Many patients received more than 1 course of antibiotics during hospitalization. This study highlights the importance and demand for appropriate antibiotic stewardship practices in COVID-19 patients.

A study was performed on 517 surveillance rectal swabs to evaluate a selective and differential chromogenic medium, the BBL CHROMagar VanRE (CVRE), which enables recovery and identification of VanA-and VanB-containing Enterococcus faecium (ENFM) and Enterococcus faecalis (ENFS) isolates. Compared to BBL Enterococcosel agar, a bile-esculin-azide-vancomycin (BEAV) agar, the initial overall sensitivity, specificity, and positive and negative predictive values of CVRE for the detection of vancomycin-resistant ENFM and ENFS were 99.1% and 94.8% and 84.2% and 99.7%, respectively. Among our patient population, more vancomycin-resistant enterococci (VRE) were recovered with CVRE than BEAV.Vancomycin-resistant enterococci (VRE) are major causes of nosocomial infections in health care facilities, and those patients infected with VRE have worse outcomes while hospitalized (8). Rapid, reliable identification of these antibioticresistant organisms is crucial for patient management and infection control measures (9, 12).Culture from rectal swabs or stool specimens onto bileesculin-azide agar with vancomycin (BEAV) is the VRE screening method used in many clinical laboratories. Confirmation of VRE using this medium requires 48 to 72 h. Chromogenic agars to detect VRE demonstrate promise (1-7, 10). BBL CHROMagar VanRE (CVRE; BD Diagnostics, Sparks, MD) is a selective and differential chromogenic agar under development for the detection of vancomycin-resistant E. faecium (VRENFM) and vancomycin-resistant Enterococcus faecalis (VRENFS). CVRE contains 8 g/ml of vancomycin and uses chromogenic substrates to phenotypically differentiate VRENFM as mauve colonies and VRENFS as green colonies. Other bacteria are inhibited or typically grow as a color other than mauve or green. Our study compared the clinical performance of CVRE with that of BEAV for primary isolation and detection of VRE from surveillance rectal swabs.Patient samples. This industry-sponsored clinical trial was approved by the Johns Hopkins University School of Medicine Institutional Review Board. At the Johns Hopkins Hospital, VRE surveillance cultures are obtained weekly from patients in all intensive care units (ICUs) and from other high-risk groups, such as oncology, transplant, and HIV patients. Multiple specimens per patient were permitted in the study if previous cultures were negative. Two positive specimens were admissible, provided the specimens were collected Ͼ5 days apart.Surveillance rectal swabs were first inoculated onto BEAV followed by inoculation onto CVRE. Both plates were aseptically streaked for isolation and incubated at 37°C for 24 to 48 h. BEAV. BEAV plates with 6 g/ml of vancomycin were incubated aerobically. No-growth cultures or those not consistent with VRE by 48 h had no further workup. Presumptive colonies for VRE (black colonies with a Gram stain of positive cocci) were isolated to 5% sheep blood agar (SBA) and incubated for an additional 18 to 24 h. L-Pyrrolidonyl-␤-naphthylamide enzyme (PYR)-positive colonies were identified with the BD ...