HCA Houston Healthcare’s Post

📚 Just Published: Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis. https://lnkd.in/eJ_3Zsjn 🔍 Main Findings • The authors of the included studies presented a wide range of definitions for the ‘appropriateness of antibiotic prescriptions’, comprising aspects such as antibiotic class, indication appropriateness and antibiotic dose, either individually or in combination. • A diagnosis of acute otitis media, a general practitioner (GP) as prescriber, and a rural area were identified as the main factors that drive inappropriateness of antibiotic prescriptions. • Older patient age and a respiratory tract infection (RTI) diagnosis have a tendency to be positively associated with inappropriate antibiotic prescribing, but pooling of studies was not possible. 🧐 Key Takeaways • Prioritizing acute otitis media, GPs, rural areas, older children and RTIs within antimicrobial stewardship programmes plays a vital role in promoting responsible antibiotic prescribing. • The implementation of a standardized definition of appropriateness is essential to evaluate such programmes. 👋 A special thanks to the research team for their pleasant collaboration: Jan Verbakel, Laure Wynants, Jo Wouters, and Danielle Snijders.

Choosing the right antibiotic is a common clinical challenge. Unnecessarily broad-spectrum antibiotic treatment promotes antimicrobial resistance; inappropriately narrow-spectrum antibiotic use can lead to treatment failure. Patient characteristics and features of their clinical history are predictors of antibiotic resistance; however, physicians sometime struggle to incorporate these factors when making empiric treatment decisions. Electronic medical records provide fertile ground for incorporation of decision support tools, but a robust evidence base is needed to justify their integration. Here, Derek R. MacFadden, MD, ScD, and Nick Daneman, MD, MSc, review the literature and propose a cluster-randomized trial of a model-informed clinical decision support tool for guiding empiric antibiotic therapy for hospitalized patients with suspected infection.    Read “Can Decision Support Tools Improve Empiric Antibiotic Prescribing?” by Derek R. MacFadden, MD, ScD, and Nick Daneman, MD, MSc, from the Ottawa Hospital Research Institute, the University of Ottawa, Sunnybrook, and the University of Toronto: https://eviden.cc/3NrMAv7 

We’re excited to announce the results of our comprehensive clinician survey confirming that HealthTrackRx next-morning results positively impacted antibiotic prescribing 80% of the time. Dr. Barbara Alexander, Past President of the Infectious Disease Society of America (IDSA) and Chairperson of the company's Clinical Advisory Board, remarked: "HealthTrackRx has streamlined specimen collection, developed medically relevant syndromic panels, expedited shipping and testing logistics, and simplified interpretation of results so that they are now clinically actionable for clinicians in real-time." Dr. Alexander continued, "While past studies have concluded that clinicians appear reluctant to modify initial empiric antibiotic prescriptions despite the subsequent availability of antimicrobial susceptibility results, the study from HealthTrackRx shows that this practice may be finally changing. Clinically actionable molecular diagnostics in the outpatient setting can guide directed therapy, supporting antibiotic stewardship practices, leading to better patient outcomes, and reducing overall healthcare spending.“ See the full press release https://bit.ly/4aAAHMt #HealthTrackRx #PCRTesting #AntimicrobialStewardship #GettingPeopleHealthierFaster Martin Price Steve Goldberg, MD, MBA

https://lnkd.in/gijYbSRB "A new study of clinical data from US hospitals indicates that suspected community-onset sepsis accounts for half of broad-spectrum antibiotic use, but much of it may be unnecessary. The study, published yesterday in JAMA Network Open, found that patients with suspected community-onset sepsis accounted for half of total inpatient antipseudomonal beta-lactam antibiotic and anti–methicillin-resistant Staphylococcus aureus (MRSA) antibiotic days. But antibiotic-resistant organisms were isolated from less than 10% of sepsis patients, and the proportion with resistant infections declined over time, while the proportion who received broad-spectrum antibiotics increased." Rapid AST tests can reduce time to narrow, targeted therapy - improving outcomes for patients and decreasing the development of novel antibiotic resistance. #AMR #Sepsis

🚨 AMR | New WHO Report Alert! 🚨 The latest findings from the World Health Organization (WHO) shed light on the alarming overuse of antibiotics during the COVID-19 pandemic, fueling the silent spread of antimicrobial resistance (AMR) worldwide. 🗝 Key takeaways from the report: - Despite only 8% of hospitalized COVID-19 patients needing antibiotics for bacterial co-infections, a staggering 75% were treated with antibiotics as a precaution. - Antibiotic use varied widely across regions, with rates ranging from 33% to 83%. - The highest antibiotic use was observed in patients with severe or critical COVID-19, with a global average of 81%. - Most concerning is the frequent prescription of 'Watch' antibiotics, which have a higher risk of contributing to AMR. ➕ What's more: - Antibiotic use did not improve clinical outcomes for COVID-19 patients and could potentially harm those without bacterial infections. - A systematic evidence synthesis will inform upcoming WHO recommendations on antibiotic use in COVID-19 patients. These insights, drawn from data on 450,000 hospitalized COVID-19 patients across 65 countries, highlight the urgency to rethink antibiotic prescribing practices globally. As we gear up for the UN General Assembly High-Level Meeting on AMR, let's commit to concerted efforts to combat AMR across health sectors and promote responsible antibiotic use. Join the conversation and stay informed! #AMR #WHO #AntibioticResistance #Healthcare #COVID19 Source: WHO. (2024). WHO reports widespread overuse of antibiotics in patients hospitalized with COVID-19. Access [online]: https://lnkd.in/d48kthHN

We would like to invite Australian hospitals to participate in the 2024 national benchmarked Antifungal NAPS audit. We have identified that fluconazole is the most commonly prescribed systemic antifungal agent in Australian hospitals with the highest rate of inappropriate prescribing. This year we are conducting a fluconazole targeted audit utilising the Antifungal NAPS tool, to allow a deep dive analysis of prescribing quality in order to identify key areas for quality improvement. What is being audited? All patients initiated on fluconazole in your facility What time period to audit? 1st January to 31st March 2024 How many prescriptions should be audited? All patients initiated on fluconazole during the audit period (up to 50 prescriptions). How is the Antifungal NAPS different? A deep dive audit to assess each phase of prescribing (prophylaxis, empiric, directed) Assess prescribing according to risk of invasive fungal infection New quality & outcome metrics specific for antifungal prescribing and invasive fungal infection What will your hospital gain by participating? Optimise quality of antifungal prescribing for your patients; reduce toxicity, manage drug-drug interactions, ensure usage is appropriate Benchmark performance against similar hospitals Note: Antifungal NAPS can be used for any other audit type in your hospital all year round but only fluconazole prescriptions will be incorporated in the 2024 benchmarking reports. 

Very important non-inferiority trial now published in #LancetInfectiousDiseases. Early switch to oral therapy after 5-7days of effective IV therapy for the treatment of Staph aureus bacteremia was non-inferior to full treatment course with IV therapy. Staph aureus bacteremia is one of the most feared and severe conditions infectious disease consultants have to deal with. Standard of care is IV antibiotic therapy for 2-6weeks depending on severity of the infection, complications and clinical course. However outpatient IV antibiotic therapy carries a risk of morbidity and complications for the patient which are non negligible. Having the option to switch to oral therapies early in select patients with uncomplicated infections is important. #staphaureusbacteremia #microbiology #InfectiousDiseases #ClinicalTrials https://lnkd.in/eXxquVMU

The American Gastroenterological Association (AGA) developed this guideline to provide recommendations on the use of fecal microbiota–based therapies in adults with recurrent Clostridioides difficile infection; severe to fulminant C difficile infection; inflammatory bowel diseases, including pouchitis; and irritable bowel syndrome. 1. In immunocompetent adults with recurrent C difficile infection, the AGA suggests select use of fecal microbiota–based therapies on completion of standard of care antibiotics to prevent recurrence. 2. In mildly or moderately immunocompromised adults with recurrent C difficile infection, the AGA suggests select use of conventional fecal microbiota transplant. 3. In severely immunocompromised adults, the AGA suggests against the use of any fecal microbiota–based therapies to prevent recurrent C difficile. 4. In adults hospitalized with severe or fulminant C difficile not responding to standard of care antibiotics, the AGA suggests select use of conventional fecal microbiota transplant. 5. The AGA suggests against the use of conventional fecal microbiota transplant as treatment for inflammatory bowel diseases or irritable bowel syndrome, except in the context of clinical trials https://lnkd.in/dthE3-Za

It is great news that the Longitude Prize for AMR winner is a rapid diagnostic to ensure that UTIs are being appropriately treated. Actually, you would wonder why this is so prize-worthy, surely we already have a tool to diagnose such a ubiquitous condition? Well, surely not! In fact, current tests take 2-3 days for results (with samples sent to a lab and then returned with a 24 hour or so turnaround). This new test could return a result on the pathogen in 15 minutes, and in another 30 minutes, give information on antibiotic susceptibility as well. This means doctors don't have to guess whether antibiotics are needed (and which ones), but instead will have information to guide more precise care. Something like half of all women will experience an UTI, but probably that number is higher. When something is so widespread, it becomes almost invisible - we just accept that this is something we will have to deal with at some point. And when the antibiotics work, then it's a painful, but very transient, experience (until the next one of course). When the antibiotics don't work, the outcome can look very different. Some women deal with chronic UTIs that have effectively debilitated them - they experience intense pain and suffering, cannot manage daily tasks let alone work, see big reductions in quality of life (or worse, as UTIs can also lead to sepsis)... and all for a little bacterium that has outsmarted our science. A good and timely diagnostic means the right antibiotic can be used at the right time. We can safeguard the effectiveness of antibiotics, and even use again the ones we have shelved out of fear of eroding effectiveness further. But for the ubiquitous UTI, and other bacterial infections, we also need to keep the engine of innovation running so we can have more and better antibiotics where they are needed the most.

📃Scientific paper: Characterization of Escherichia coli isolated from urinary tract infection and association between virulence expression and antimicrobial susceptibility Abstract: Background The capacity of antibiotics to modulate bacterial virulence has raised concerns over the appropriateness of antibiotic therapies, including when dosing strategies fall below sub-therapeutic levels. In this work, we investigated the ability of antibiotics to influence virulence in Escherichia coli isolated from urinary tract infection (UTI). Results Out of 120 isolates, 32.5% carried pap , 21.7% carried hlyA , and 17.5% carried cnf . The predominant B2 phylogroup was significantly associated with the quinolone-resistant isolates. A significant association was seen between the presence of hlyA hemolysin and susceptibility to ceftriaxone and ciprofloxacin ( P  < 0.05). Sub-inhibitory concentrations of both antibiotics reduced the levels of hlyA expression and hemolysis in isolates treated with antibiotics compared to untreated isolates ( P  < 0.05). Growth rate assay showed that the decrease in hlyA expression was not an effect of decreased growth rate. Conclusion Our study indicated the inhibitory effect of ciprofloxacin and ceftriaxone on the level of hemolysis, suggesting that the sub-inhibitory concentrations of these antibiotics may affect the outcome of infections. Further studies, including animal models may elucidate the outcome of virulence modulation by these antibiotics in UTI pathogenesis. Continued on ES/IODE ➡️ https://etcse.fr/UyOjJ ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.