New AHRQ guide to help nursing homes implement stewardship programs
The Agency for Healthcare Research and Quality has released a new online guide to help nursing homes address the challenge of creating and implementing an antimicrobial stewardship program (ASP).
The AHRQ Antimicrobial Stewardship Guide comes on the heels of a new rule finalized by the Centers for Medicare and Medicaid Services (CMS) in early October that requires nursing homes and other long-term care facilities to have an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use. According to the Centers for Disease Control and Prevention (CDC), an estimated 70% of nursing home residents receive one or more courses of antibiotics during a year, and studies have indicated that anywhere from 40% to 70% of those antibiotics prescriptions are inappropriate.
Among the challenges facing nursing homes in creating and implementing an ASP are a lack of financial resources, antibiotic stewardship expertise, and diagnostic and support services. In addition, medical care at nursing homes is often poorly coordinated.
The guide, which was pilot-tested in nine nursing homes, provides several toolkits to help nursing homes optimize their use of antibiotics. The toolkits offer guidance on how to implement and sustain an ASP, how to determine when antibiotics are necessary, how to choose the right antibiotic for treating an infection, and how to educate residents and family members about antibiotics.
"We're committed to ASPs because they're essential to our broad national effort to maintain the effectiveness and safety of the nation's antibiotics," writes James Cleeman, MD, director of AHRQ's division of healthcare-associated infections, in a blog post.
AHRQ Nursing Home Antimicrobial Stewardship Guide
Oct 27 AHRQ Views blog post
Study examines types of stewardship at small community hospitals
A study presented at IDWeek 2016 found that higher-level antibiotic stewardship programs (ASPs) resulted in greater reduction in antibiotic use in small community hospitals.
The purpose of the study, which was the featured oral abstract of the Society for Healthcare Epidemiology of America, was to compare the impact of three different types of ASP in a network of small community hospitals operated by Utah-based Intermountain Healthcare. Small community hospitals account for nearly 75% of all US hospitals, but only about 22% have an ASP.
In the cluster-randomized control trial, investigators randomly assigned the 15 small community hospitals to one of the three ASP models: Five hospitals were assigned to program 1, a reference group that had a minimal ASP program; five hospitals were assigned to program 2, which featured stewardship education, a limited prospective audit and feedback program, and antibiotic restrictions that were controlled by local pharmacy staff; and five hospitals were in program 3, which featured an expanded prospective audit and feedback program, antibiotic restrictions overseen by both a pharmacist and an infectious disease (ID) physician, and ID physician review of all culture results.
The primary outcomes were total antibiotic use and broad-spectrum antibiotic use. Secondary outcomes included mortality rates, readmission rates, and incidence of Clostridium difficile.
In the final analysis, the investigators found that the small community hospitals in program 3 reduced total antibiotic use by 17% compared to program 1, but the hospitals in program 2 showed no statistically significant reduction compared to those in program 1. Both program 2 and 3 hospitals reduced broad spectrum use by 31% and 27%, respectively, compared to hospitals in program 1. An analysis of secondary outcomes showed no difference in mortality or patient readmission rates among the different programs, but programs 2 and 3 saw 45% fewer cases of C difficile compared to program 1.
"Stewardship programs are now known to be feasible in small community hospitals, and they can reduce antibiotic use if the appropriate resources are out there," lead author Edward Stenehjem, MD, MSc, told the audience.
Oct 28 Stewardship in community hospitals abstract
ID consultations can save lives, single-center study finds
Consulting an infectious diseases (ID) specialist can reduce mortality in patients with multi-drug resistant Gram-negative infections, according to a study presented at IDWeek 2016.
The single-center, retrospective, case-cohort study included 205 patients at SUNY Downstate Medical Center in Brooklyn, N.Y., who were being treated for bacteremias and urinary tract infections. Of the 205 patients, 40 patients received early ID consultation (within 48 hours), 25 received late ID consultation (after 48 hours), and 140 received no consultation. The two most common organisms isolated were extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae.
Overall, 60 patients died during the study. Forty-five of the deaths occurred in patients who received no ID consult, and 15 occurred among those patients who received late ID consultation. None of the patients who received early ID consultation died. In addition, mean time to defervescence (fever reduction) was estimated at 1.8 days for early consult, 5.3 days for late consult, and 4.9 days for no consult.
The study adds to research showing that when an ID specialist is involved in a patient's care, patients are correctly diagnosed more often, have fewer complications, and have better outcomes.
Oct 29 ID consultations abstract