Antimicrobial stewardship intervention bundle decreases outpatient fluoroquinolone prescribing for urinary tract infections

Cubillos, Ashley L; Patch, Megan; Chandler, Elisabeth; Lynch, Leah W; Gieselman, Morris R; Saunders, Mary; Calkins, Karen E

doi:10.1017/ice.2021.520

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Outpatient ASP metrics are often “encounter based” (eg, encounter-level prescribing rates), and encounter-level diagnosis codes are commonly leveraged to associate antimicrobial prescribing with specific infectious syndromes. 3,4 A tiered diagnostic approach has commonly been applied wherein encounter ICD-10 codes are stratified into syndromes for which antibiotics are always, sometimes, or never appropriate (eg, tier I, II, and III, respectively). 5,6 This approach has allowed institutions to stratify encounters by syndrome(s) within data models; however, reliance on diagnoses coding also introduces inaccuracies when code selection is incorrect or lacks specificity.…”

Section: Discussionmentioning

confidence: 99%

Cracking the code(s): Optimization of encounter-level diagnosis coding to inform outpatient antimicrobial stewardship data modeling

Stevens,

Manz,

Mathre

et al. 2024

Infect. Control Hosp. Epidemiol.

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letters were mailed to 140 patients recommending HIV, hepatitis B, and hepatitis C testing. After receiving the notification letter, patient D contacted the clinic. He was hospitalized for hepatitis C in a different county during August 2022. Patient D received a procedure on the same day, in July, as the other 3 patients and immediately after patient B. To encourage testing and to ensure receipt of exposure notification letters, we called all 140 patients; 100 (71%) were successfully contacted and 76 (54%) reported they had scheduled or completed recommended postexposure testing. Recommendations to the clinic included updated infection control practices, proper use of syringes and needles, keeping multidose vials in a dedicated clean medication preparation area (away from immediate patient treatment areas), staff training, and an outbreak notification sign for the clinic to post. 8 We continued cross referencing the exposure patient list with the California Department of Public Health and LACDPH HCV registries. No additional patients with a positive HCV RNA test result were reported.Although we were unable to identify a specific source of HCV transmission, evidence supports the possibility that a multidose medication vial was contaminated by reuse of a needle or syringe. Improper handling of multidose vials has been linked to multiple bloodborne pathogen outbreaks 2,3 and are the basis of CDC recommendations for safe injection practices when using multidose vials. 9 Single-use vials, drawing medication outside the patient's room, and random audits of infection control practices by infection prevention staff or departments of public health could prevent future outbreaks. 9 Our investigation highlights an ongoing need to assure that providers consistently apply policies and procedures to prevent healthcare-associated transmission of bloodborne pathogens when using multidose vials.

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Section: Discussionmentioning

confidence: 99%

Cracking the code(s): Optimization of encounter-level diagnosis coding to inform outpatient antimicrobial stewardship data modeling

Stevens,

Manz,

Mathre

et al. 2024

Infect. Control Hosp. Epidemiol.

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“…Despite regulatory indication changes and guideline recommendation updates, recent research demonstrates that antibiotic de-escalation initiatives continue to be needed at the institutional level and indeed should be considered “critical infrastructure” [ 10 , 24 ]. The current study serves to continue such discussions, and the high incidence of inappropriate FQ use observed clearly demonstrates the opportunity for focused stewardship efforts at discharge.…”

Section: Discussionmentioning

confidence: 99%

Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis

Hayden,

White,

Neely

et al. 2023

Open Forum Infectious Diseases

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Background Fluoroquinolones (FQ) are associated with adverse effects and increasing resistance. However, uncomplicated cystitis remains a frequent reason for FQ use. Selective reporting involves withholding susceptibilities for select antimicrobial agents on microbiology reports, in hopes of dissuading use by providers. The purpose of this study was to investigate the impact of FQ susceptibility suppression on discharge prescribing for hospitalized patients with uncomplicated cystitis. Methods This was a retrospective, quasi-experimental analysis in adult patients at a 350-bed academic medical center to compare the incidence of FQ prescribing for cystitis at hospital discharge, pre- and post-implementation (March 1, 2017–March 31, 2019) of a policy to suppress FQ urinary susceptibility results for pan-susceptible Klebsiella spp. and Escherichia coli. FQ appropriateness and risk factors for FQ use were also examined. Results There was a relative risk reduction of 39% in discharge FQ prescribing when adjusted for discharge team (aRR 0.61 [CI 0.40-0.93]). Almost all FQ use was inappropriate, largely due to organisms’ susceptibility to a guideline-preferred agent (n = 61). In multivariate analysis, odds ratios of discharge FQ prescribing were 0.22 [CI 0.12-0.39] for insured patients, 0.43 [CI 0.21-0.86] for patients with antibiotic allergy, and 57.8 [CI 13.7-244] for those receiving inpatient FQ. Discharge from a medicine team was protective against discharge FQ prescribing. Conclusions Together with multidisciplinary inpatient medicine services and avoidance of inpatient FQ use, suppression of FQ susceptibilities on pan-susceptible urine isolates for Klebsiella spp. and E. coli may represent an attractive strategy for antibiotic stewardship at hospital discharge.

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“…Reflectance probes can be secured around the distal limb or tail base, and a spot reading can be performed in the femoral area ( 63 ). It is important to recognize that poor circulation or perfusion can influence SpO 2 ( 11 ). The transmittance probe can be clipped to any mucous membrane such as the tongue or lip ( 63 ).…”

Section: Ventilated Patient Carementioning

confidence: 99%

Nursing strategies for the mechanically ventilated patient

Meitner,

Feuerstein,

Steele

2023

Front. Vet. Sci.

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The goal of this manuscript is to provide a comprehensive and multi-disciplinary review of the best nursing practices of caring for mechanically ventilated patients. By reviewing human medicine literature, the authors will extrapolate procedures that have been found to be most effective in reducing the risk of mechanical ventilation (MV) complications. Paired with review of the current standards in veterinary medicine, the authors will compile the best practice information on mechanically ventilated patient care, which will serve as a detailed resource for the veterinary nursing staff. Written from a nursing standpoint, this manuscript aims to consolidate the nursing assessment of a mechanically ventilated patient, addressing both systemic and physical changes that may be encountered during hospitalization. The goal of this review article is to present information that encourages a proactive approach to nursing care by focusing on understanding the effects of polypharmacy, hemodynamic changes associated with MV, complications of recumbent patient care, and sources of hospital acquired infections. When applied in conjunction with the more technical aspects of MV, this manuscript will allow veterinary technicians involved in these cases to understand the dynamic challenges that mechanically ventilated patients present, provide guidance to mitigate risk, address issues quickly and effectively, and create an up-to date standard of practice that can be implemented.

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Antimicrobial stewardship intervention bundle decreases outpatient fluoroquinolone prescribing for urinary tract infections

Cited by 4 publications

References 9 publications

Cracking the code(s): Optimization of encounter-level diagnosis coding to inform outpatient antimicrobial stewardship data modeling

Cracking the code(s): Optimization of encounter-level diagnosis coding to inform outpatient antimicrobial stewardship data modeling

Impact of Fluoroquinolone Susceptibility Suppression on Discharge Prescribing for Acute Uncomplicated Cystitis

Nursing strategies for the mechanically ventilated patient

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