Reduce Unnecessary Use of Broad-Spectrum Agents-References

References

• Chotiprasitsakul D, et al. The Role of Negative Methicillin-Resistant Staphylococcus aureus Nasal Surveillance Swabs in Predicting the Need for Empiric Vancomycin Therapy. Open Forum Infect Dis 2017.
• At the studied institution with robust infection control practices and low nosocomial MRSA transmission rates, patients with negative MRSA nasal swabs had a very low likelihood of subsequent MRSA infection during hospitalizations. MRSA nasal swabs can provide useful information when determining whether to initiate or stop empiric vancomycin.

• Jones BE, et al. Empirical Anti-MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for Pneumonia. JAMA IM 2020.
  • National cohort study of ~89,000 hospitalizations for pneumonia which concluded that, in the studied population, there was no benefit on mortality in the setting of empiric anti-MRSA therapy vs standard antibiotic treatment, including for those who had risk factors for MRSA.
• Magill SS, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open 2021.
  • A cross-sectional study that aimed to evaluate appropriateness of antibiotic use for inpatients treated for CAP or UTI, or with fluoroquinolones or vancomycin. The study concluded that 55.9% of patients had unsupported treatment, with common reasons for this being excessive duration and lack of documentation of signs/symptoms of infection.
• Musgrove MA, et al. Microbiology Comment Nudge Improves Pneumonia Prescribing. Open Forum Infect Dis 2018.
  • A simple, behavioral nudge in microbiology reporting increased de-escalation and discontinuation of unnecessary broad-spectrum antibiotics. This highlights the importance of clear, persuasive communication of diagnostic testing in improving antibiotic prescribing behaviors.
• The Pew Charitable Trusts. Health Experts Establish Targets to Improve Hospital Antibiotic Prescribing. Pew Trusts 2021.
  • This report shows the findings from a 3-year partnership between The Pew Charitable Trusts and the CDC/other public health/medical experts to analyze hospital antibiotic usage and set national targets aimed at improving prescribing. One key finding noted that approximately 56% of antibiotic prescriptions were inappropriate (for choice, duration, or illness treated). It was concluded that an appropriate way to meet new national targets for antibiotic prescribing was the adoption of an antibiotic stewardship program.
• Rhee C, et al. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated with Inadequate and Broad-Spectrum Empiric Antibiotic Use. JAMA Netw Open 2020.
• Cohort study of 17,430 adults with culture-positive sepsis which shows that broad-spectrum antibiotics were frequently administered to patients. These patients often did not have resistant pathogens and the administration of unnecessarily broad antibiotics was associated with worse outcomes.
• Seddon MM, et al. Role of Early De-escalation of Antimicrobial Therapy on Risk of Clostridioides difficile Infection Following Enterobacteriaeceae Bloodstream Infections. Clin Infec Dis 2019.
• The empirical use of antipseudomonal beta-lactam (APBL) therapy for >48 hours was an independent risk factor for C. diff infection. Early de-escalation of APBL using clinical risk assessment tools or rapid diagnostic testing may reduce the incidence of CDI in hospitalized adults with Enterobacteriaceae BSIs.
• Vaughn V, et al. Inpatient and Discharge Fluoroquinolone Prescribing in Veterans Affairs Hospitals Between 2014 and 2017. Open Forum Infect Dis 2020.
• Retrospective cohort study at 125 VA hospitals which showed that, over the 3 years studied, fluoroquinolone use had declined following the implementation of a mandatory antibiotic stewardship program in 2014. However, it is noted that there is still work to be done in relation to prescription of fluoroquinolones at discharge.
• Vaughn V, et al. The Association of Antibiotic Stewardship with Fluoroquinolone Prescribing in Michigan Hospitals: A Multi-Hospital Cohort Study. Clin Inf Dis 2019.
• Hospital-based stewardship interventions targeting fluoroquinolone prescribing were associated with less fluoroquinolone prescribing during hospitalization, but not at discharge. To limit aggregate fluoroquinolone exposure, stewardship programs should target both inpatient and discharge prescribing.
• Webb B, et al. Broad-Spectrum Antibiotic Use and Poor Outcomes in Community-Onset Pneumonia: A Cohort Study. Euro Resp Journ 2019.
• Observational cohort study of 1,995 adults with community-onset pneumonia where 39.7% of patients received broad-spectrum antibiotics, but only 3% had MDRO. The receipt of broad-spectrum antibiotics was associated with increased mortality, longer hospital stays, greater cost, and increased C. difficile rates.

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