Cascade reporting linked to drop in fluoroquinolone prescribing
A study conducted in a network of urgent care and express care clinics in Iowa found that implementation of cascade reporting was associated with a significant decline in fluoroquinolone prescribing, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.
The analysis by researchers with UnityPoint Health and the University of Iowa-Des Moines looked at antibiotic prescriptions per 1,000 patient encounters (PE) at seven urgent care and two express care clinics in the period before (June 2018 through June 2019) and after (August 2019 through December 2020) implementation of cascade susceptibility reporting, which is a type of selective reporting in which antimicrobial susceptibility results of secondary antibiotics are reported only if an organism is resistant to primary antibiotics.
At the clinics, susceptibility results for Enterobacterales isolates in urine cultures were reported for fluoroquinolones only if the isolates were resistant to trimethoprim-sulfamethoxazole, nitrofurantoin, and cefazolin.
In the 12 months prior to the intervention, the median fluoroquinolone prescribing rate was 24.6 prescriptions per 1,000 PE, compared with a median of 8.23/1,000 PE in the post-intervention period. Estimates from an interrupted time series analysis showed a 38% reduction following implementation of the intervention, and no change in slope was detected. Of the three primary antibiotics, only nitrofurantoin saw an increase in median prescribing rates post-intervention.
The study authors say the findings are noteworthy because, while antibiotic prescribing varies widely in the urgent care setting, urgent care clinics have seldom been the target of antimicrobial stewardship interventions.
"In conclusion, cascade reporting of antimicrobial susceptibility of Enterobacterales in urine cultures is a feasible and sustainable antimicrobial stewardship that can be applied in urgent care and express care clinics in an integrated health system," they wrote.
Jun 20 Antimicrob Steward Healthc Epidemiol study
Study: Sporicidal disinfectant, thorough cleaning cuts hospital-onset C diff
A sporicidal cleaning intervention implemented at eight acute care hospitals resulted in more thorough cleaning of hospital rooms and was associated with a reduction in hospital-onset Clostridioides difficile (HO-CDI) infections, researcher reported today in Infection Control & Hospital Epidemiology.
In the quasi-experimental study, researchers compared the eight hospitals that implemented the hospital-wide sporicidal cleaning intervention with nine control hospitals from the same healthcare system that didn't implement the cleaning program. The intervention began with environmental services technicians and managers from the hospitals participating in education and training sessions, then adding daily hospital-wide, patient-zone, surface-disinfection cleaning with a sporicidal disinfectant cleaner to their traditional disinfection regimen for rooms occupied by CDI patients.
A structured performance monitoring and feedback program using the fluorescent marker system was added to measure thoroughness of disinfection cleaning (TDC)—a measurement of the percentage of patient zone surfaces that have been disinfected—and optimize cleaning practice. The researchers then compared pre- and post-intervention monthly HO-CDI rates at the intervention and control hospitals.
Following a 3-month wash-in period to evaluate the 18-month pre-intervention cleaning performance, the TDC improved steadily from 59% to 86% at all eight sites post-intervention, and by 18 months was 93.6% for the group. The mean standardized infection ratio (SIR) of HO-CDI decreased from 1.03 in the pre-intervention period to 0.6 (95% confidence interval [CI], 0.13 to 0.75) post-intervention. In the adjusted difference-in-differences analysis in comparison to control hospitals, there was a 0.55 reduction (95% CI, −0.77 to −0.32) in HO-CDI, or a 50% relative decrease from baseline.
"This study provides support for the clinical benefit of an integrated 4-component intervention, not bundled with other transmission mitigating activities, focusing solely on environmental hygiene practice that includes daily, hospital-wide sporicidal disinfectant cleaning with objectively optimized thoroughness of cleaning to reduce endemic HO-CDI," the study authors wrote.
Jun 20 Infect Control Hosp Epidemiol abstract