Study spotlights excess antibiotics in discharged hospital patients
A study conducted at Johns Hopkins Hospital found that three-quarters of patients evaluated were prescribed excess antibiotics at discharge, and durations were frequently longer than recommended, researchers reported last week in the American Journal of Infection Control.
For the study, researchers reviewed data on adult patients discharged from Johns Hopkins Hospital on oral antibiotics from July through August 2020, assessing antibiotic indication, appropriateness of antibiotics, and treatment duration. Excess duration was defined as days of therapy prescribed beyond institutional or national guideline-recommended treatment durations.
During the study period, 196 patients were discharged on antibiotics, with 147 (75%) prescribed excess antibiotic days. Antibiotic choice was appropriate in 70.4% of cases, but the discharge duration was appropriate in only 32.1% of cases based on antibiotic indication, and the total duration of therapy was identified as appropriate in just 24.5% of cases. Compared to all patients, those who received excess antibiotics at discharge had lower rates of appropriate therapy based on antibiotic indication. Excess antibiotic duration was particularly likely for unknown diagnosis (23%), skin and soft tissue infections (16%), and antibiotic prophylaxis (12%).
The study authors say improved adherence to recommended antibiotic prescribing practices prior to and at hospital discharge and through the completion of therapy is an "important but under-addressed" target for antibiotic stewardship.
"Increasing antimicrobial stewardship efforts in both the outpatient setting and at hospital or emergency department discharge can improve antibiotic prescribing by clinicians and ensure that antibiotics are only prescribed when necessary," they wrote.
Sep 10 Am J Infect Control abstract
Study finds MRSA bacteremia rate much higher in NYC COVID-19 patients
The rate of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was five times higher among COVID-19 patients than non-COVID patients at 11 New York City hospitals during the pandemic, researchers reported last week in Infection Control & Hospital Epidemiology.
From January 2019 through March 2022, there were 216 cases of healthcare facility-onset (HCFO) MRSA bacteremia across the 11 public acute care medical centers within New York City Health and Hospitals Enterprise, a healthcare system that serves primarily low-income patients in the Bronx, Brooklyn, Manhattan, and Queens. The baseline rate of MRSA bacteremia was 0.073 per 1,000 patient-days in 2019, and during four COVID-19 surges it climbed to 0.53, 0.20, 0.51, and 0.43 infections per 1,000 patient-days. From January 202o through March 2022, the overall rate of MRSA bacteremia in patients without COVID-19 was 0.065 per 1,000 patient-days, and 0.34 per 1,000 patient-days in patients with a diagnosis of COVID-19.
Compared with patients without COVID-19, MRSA bacteremia patients with COVID-19 were older (67.2 vs 55.6 years), more likely to be Asian (31% vs 4%), less likely to be Black (13% vs 36%), and more likely to be located in an intensive care area at the time of MRSA bacteremia (58% vs 34%). In addition, 77% of the patients with COVID-19 were on mechanical ventilation, 63% were on corticosteroids, and 79% met the National Healthcare Safety Network definition of pneumonia. Mortality rates were higher for patients with COVID-19 (81% vs 34%), and only 4% of patients with HCFO MRSA bacteremia and COVID-19 were discharged home, compared with 23% of patients without COVID-19.
The study authors say prolonged hospitalization and the high rates of corticosteroid use and mechanical ventilation likely contributed to superimposed MRSA infection, as did increased use of the antibiotic ceftriaxone during the initial surge of COVID-19. They also suggest the number of central-line associated MRSA bacteremia cases may be underestimated.
"The elevated rates of HCFO MRSA bacteremia during the pandemic once again emphasizes the important role of antibiotic stewardship and infection control efforts, especially during surges of patients with COVID-19," they wrote.
Sep 9 Infect Control Hosp Epidemiol abstract