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Stewardship / Resistance Scan for Sep 29, 2021

Stewardship / Resistance Scan for Sep 29, 2021

Study finds CDC-based stewardship intervention is cost-effective

An intervention based on the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship yielded cost savings at 10 outpatient Veterans Healthcare Administration (VHA) sites, researchers reported today in Infection Control & Hospital Epidemiology.

The intervention, implemented in September 2017, used a provider-directed audit feedback and academic detailing approach to promote appropriate diagnosis and treatment of uncomplicated acute respiratory tract infections (ARIs). To evaluate the cost-effectiveness of the intervention, researchers developed an economic simulation model from the health system perspective and compared antibiotic prescribing, appropriate treatment, adverse drug events, and hospitalizations at intervention sites and control (usual care) sites. The effectiveness measure was quality-adjusted life-years (QALYs). Costs included those related to treatment of ARIs and associated care, and costs incurred to implement the intervention.

A total of 16,712 and 51,725 patient visits occurred at the intervention and control sites, respectively. The proportion of ARI patient-visits with antibiotics prescribed at intervention sites was lower (62% vs 74%), appropriate treatment was higher (51% vs 41%), and hospitalization was lower (1.6% vs 1.9%) compared with control sites. The estimated intervention cost over a 2-year period was $133,604. The intervention had lower mean costs ($528 vs $565) and similar mean QALYs (0.869 vs 0.868) per patient compared with usual care. The cost savings were mainly driven by reductions in antibiotic prescribing and hospitalization.

“We conclude that the intervention compared to usual care is the preferred strategy for patients with uncomplicated ARI visits conditional on the decreased chance of hospitalization because of the intervention,” the study authors write. “These findings may provide decision makers with a comparable benchmark for evaluating the antibiotic stewardship intervention.”
Sep 29 Infect Control Hosp Epidemiol abstract


Medical record message linked to improved C diff antibiotic prescribing

In another study published today in the same journal, researchers reported that antibiotic prescribing for Clostridioides difficile infections (CDIs) improved at a health system in Michigan after a clinical decision support message was added to the electronic medical record.

Researchers at the Henry Ford Health System analyzed patient treatment for an initial CDI episode before and after a best practice advisory (BPA) was added to the electronic medical record to assist with antibiotic prescribing for CDI in the system’s outpatient medical centers. The BPA alert stated “Vancomycin or fidaxomicin are preferred over metronidazole for C. difficile infection” per guidelines from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, and it displayed buttons to remove the order for metronidazole and place an order for a 10-day course of vancomycin.

The primary outcome of the study was the proportion of patients who received guideline-concordant CDI therapy. Secondary outcomes included clinical response, recurrence, and unplanned healthcare encounter.

A total of 189 patients were included in the study, with 92 treated before the BPA and 97 after the BPA. The BPA was accepted 23 of 26 times and was used to optimize the therapy of 16 patients in 6 months. After implementation of the BPA, guideline-concordant therapy increased (72% before vs 91% after), vancomycin prescribing increased (72.8% vs 86.6%), and metronidazole prescribing decreased (28.3% vs 10.3%). There was no difference in clinical response or unplanned encounter within 14 days after treatment initiation. Fewer patients after the BPA had CDI recurrence within 14 to 56 days of the initial episode (27% vs 7%).

“A targeted BPA is an effective stewardship intervention that may be especially useful in settings with limited antimicrobial stewardship resources,” the study authors conclude.
Sep 29 Infect Control Hosp Epidemiol abstract

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