Infection Control Today

JUN 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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6 ICT June 2019 www.infectioncontroltoday.com editor's letter EDITORIAL Kelly M. Pyrek Editor-in-Chief kpyrek@mmhgroup.com Daniel R. Verdon Vice President, Content and Strategy dverdon@mmhgroup.com PUBLISHING & S ALE S Thomas W. Ehardt President William Mulderry Group Publisher wmulderry@mmhgroup.com John Currid Publisher/Director of Sales jcurrid@mmhgroup.com Jillyn Frommer Permissions & International License jfrommer@mmhgroup.com Subscription Customer Service (800) 581-1811 MARK E TING Amy Erdman Vice President aerdman@mmhgroup.com Melissa Devlin Marketing Manager mdevlin@mmhgroup.com PRODUC TION Robert Rys Art Director Bonnie Streit Ad Production Manager MULTIMEDIA HE ALTHCARE LLC www.infectioncontroltoday.com Antibiotic Stewardship in the Outpatient Setting Kelly M. Pyrek Editor in Chief kpyrek@mmhgroup.com T he pressure to prescribe isn't only e n c o u n t e r e d i n t h e a c u t e - c a r e environment; a recent study in AJIC found that outpatient healthcare providers inappropriately prescribed antibiotics to 40 percent of patients in a major Veterans Affairs healthcare system. Researchers within the Veterans Affairs Western New York Healthcare System used an electronic antibiotic alert following prescription to understand the most common causes of inappropriate antibiotic use. They ultimately identifi ed four conditions that often led to over-prescription: urinary tract infections (UTIs), bronchitis, skin structure infections, and sinusitis. The study also identifi ed the most commonly overused antibiotics, which included azithromycin, ciprofloxacin, amoxicillin/ clavulanate, and cephalexin; these four drugs accounted for nearly 80 percent of unnecessary drug use in the outpatient setting. Outpatient antibiotic prescriptions comprise 60 percent of overall antibiotic use, making them a critical target for antimicrobial stewardship initiatives. Improper use of antibiotics has been associated with increased morbidity, costs, and the proliferation of resistant bacteria. The study also found that patients seen in emergency departments were twice as likely to receive an antibiotic only when needed, compared to patients seen in outpatient clinics; according to the study authors, this suggests that patients seen in the emergency room are more likely to have legitimate antibiotic needs. "We found that real-time alerts when an antibiotic is prescribed, allowing for immediate intervention, may be an effective way to begin a stewardship program, supplemented by patient education on when an antibiotic is not needed and the harmful effects of misuse," says Alexis White, PharmD, the lead study author. The alert system enabled researchers to conduct a thorough chart review of all antibiotic prescriptions, evaluating for set criteria and stewardship targets. A drug's use as fi rst-line therapy, dosing, and duration were all used as benchmarks for appropriate prescription. Ad dit i o nal key f indings fro m t h e study included: • Patients with a diagnosis of sinusitis did not require an antibiotic in 32 percent of cases, as their symptoms were consistent with the common cold. Furthermore, with a sinusitis diagnosis, the incorrect drug was chosen in 53 percent of cases. • Prescribing patterns associated with UTIs indicate that the correct drug was chosen in 54.9 percent of cases. Antibiotics were most commonly prescribed for asymptomatic urine bacteria, a condition that does not require antibiotics. • 55 percent of the 288 prescriptions for azithromycin were deemed unnec- essary, and it was most commonly misused for bronchitis, sinusitis, upper respiratory tract infections, chronic obstructive pulmonary disease, and community-acquired pneumonia. "Antimicrobial stewardship programs are common in inpatient scenarios, but this research reinforces the point that there continues to be a signifi cant need to build momentum for such initiatives in the outpatient setting," says 2019 APIC president Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. "Using a targeted approach, as recommended by the study authors, may be an effective intervention to reduce inappropriate prescribing." Until next month, bust those bugs! Ò Outpatient antibiotic prescriptions comprise 60 percent of overall antibiotic use, making them a critical target for antimicrobial stewardship initiatives.

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