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Stewardship / Resistance Scan for Aug 31, 2021

Stewardship / Resistance Scan for Aug 31, 2021

Survey: Those with minor symptoms more likely to OK delayed antibiotics

Severity and the type of symptoms experienced appear to be the biggest factors in accepting a delayed antibiotic prescription for a respiratory tract infection (RTI), according to a UK survey published yesterday in PLOS Medicine.

The survey, completed by 802 adults and 801 parents in the United Kingdom, presented respondents with 12 hypothetical scenarios in which they or their child might need an antibiotic for an RTI, and whether they would accept an immediate or delayed prescription from their primary care physician. While UK primary care guidelines recommend a delayed prescription for RTIs—under which patients are advised to initiate antibiotics only if their condition worsens—uptake of the practice has been modest, and researchers want to better understand the factors that affect people’s decisions.

Non-parent adults were more likely to accept a delayed prescription for minor symptoms like a cough and runny nose (probability, 53%) or a sore throat with swollen glands (47%) than for a sore throat with swollen glands and a fever (37%) or a cough with a fever (30%), and they were less likely to accept a delayed prescription with increasing duration of illness (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.92 to 0.96). Parents showed an even more marked reduction when it came to delaying prescription amid lengthening illness (OR, 0.83).

Women were more likely than men to choose a delayed prescription for minor symptoms (62% probability vs 45% probability). Similar higher probability patterns for delaying prescription for minor symptoms were observed in older adults, those who were knowledgeable about antibiotics, and those who had been prescribed antibiotics in the past year.

The authors of the survey say presenting specific scenarios may have prompted responses that more closely reflect decisions that would be made in real life.

“Our findings could help to reduce consumption of antibiotics in primary care by encouraging primary care physicians to increase their use of delayed prescription in those groups who are more open to this approach and to specifically address concerns such as illness duration,” they wrote. “Educational interventions to improve understanding of antibiotics could target those who are less amenable to delayed prescription and focus on the (lack of) role of antibiotics in sore throat.”
Aug 30 PLOS Med study


Study links ICU stewardship to small reduction in antibiotic use

A randomized crossover study of antibiotic stewardship rounds (ASRs) in intensive care units (ICUs) found a small but measurable reduction in antibiotic use, Duke University researchers reported yesterday in Clinical Infectious Diseases.

The study involved five adult ICUs at Duke University Hospital from October 2017 to June 2018, and researchers compared antibiotic use during and after ICU stay in units with weekly ASRs and those assigned to routine care. The ASRs involved weekly face-to-face meetings with physicians and pharmacists from the antibiotic stewardship and ICU teams, and discussions of antibiotic optimization for reviewed patients.

The analysis included 4,683 patients, with 2,330 in the intervention group and 2,353 in the control group. Teams performed 761 reviews during ASRs, which excluded 1,569 patients from review.

The rate ratio (RR) of antibiotic use in days of therapy per 1,000 days present was 0.97 (95% CI, 0.91 to 1.04), but there was a large variation in effect size when the analysis was stratified by unit. When the unit with the highest percentage of patients excluded from ASRs (the cardiothoracic ICU) was removed, the RR was 0.93 (95% CI, 0.89 to 0.98). Antibiotic use in all five ICUs in the post-study period declined by 16% compared to antibiotic use in the baseline period, with the largest reduction observed in the neurology ICU (—28%) and the smallest in the cardiothoracic ICU (–2%).

The study authors say the results highlight the importance of customizing antibiotic stewardship strategies to match the patient population, workflow, and culture in each unit. They also note that, because ASRs are such a high-resource intervention, sustainability may be a challenge.

“Thus, future study is needed to develop selection tools that assist in identifying clinical scenarios that are most likely to result in meaningful stewardship interventions to reduce the personnel time required for reviews,” they wrote.
Aug 30 Clin Infect Dis abstract

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