Administration Of Antibiotics In Patients Research Articles

Nurse-Initiated Protocol to Improve Timely Antibiotic Administration in Pediatric Open Fractures.

Early administration of antibiotics in the presence of open fractures is critical in reducing infections and later complications. Current guidelines recommend administering antibiotics within 60min of patient arrival to the emergency department, yet trauma centers often struggle to meet this metric. This study aims to evaluate the impact of a nurse-initiated evidence-based treatment protocol on the timeliness of antibiotic administration in pediatric patients with open fractures. A retrospective pre-post study of patients who met the National Trauma Data Standard registry inclusion criteria for open fractures of long bones, amputations, or lawn mower injuries was performed at a Midwestern United States Level II pediatric trauma center. The time of patient arrival and time of antibiotic administration from preimplementation (2015-2020) to postimplementation (2021-2022) of the protocol were compared. Patients transferred in who received antibiotics at an outside facility were excluded. A total of N =73 participants met the study inclusion criteria, of which n =41 were in the preimplementation group and n =32 were in the postimplementation group. Patients receiving antibiotics within 60min of arrival increased from n =24/41 (58.5%) preimplementation to n =26/32 (84.4%) postimplementation (p<.05). Our study demonstrates that initiating evidence-based treatment orders from triage helped decrease the time from arrival to time of antibiotic administration in patients with open fractures. We sustained improvement for 24months after the implementation of our intervention.

Oral vs Intravenous Discharge Antibiotic Regimens in the Management of Intra-abdominal Abscesses in Penetrating Crohn's Disease.

Antibiotics are a cornerstone in management of intra-abdominal abscesses in Crohn's disease (CD). Yet, the optimal route of antibiotic administration is poorly studied. We aimed to compare surgical and nonsurgical readmission outcomes for patients hospitalized for intra-abdominal abscesses from CD discharged on oral (PO) or intravenous (IV) antibiotics. Data for patients with CD hospitalized for an intra-abdominal abscess were obtained from 3 institutions from January 2010 to December 2020. Baseline patient characteristics were obtained. Primary outcomes of interest included need for surgery and hospital readmission within 1 year from hospital discharge. We used multivariable logistic regression models and Cox regression analysis to adjust for abscess size, history of prior surgery, history of penetrating disease, and age. We identified 99 patients discharged on antibiotics (PO = 74, IV = 25). Readmissions related to CD at 12 months were less likely in the IV group (40% vs 77% PO, P = .01), with the IV group demonstrating a decreased risk for nonsurgical readmissions over time (hazard ratio, 0.376; 95% confidence interval, 0.176-0.802). Requirement for surgery was similar between the groups. There were no differences in time to surgery between groups. In this retrospective, multicenter cohort of CD patients with intra-abdominal abscess, surgical outcomes were similar between patients receiving PO vs IV antibiotics at discharge. Patients treated with IV antibiotics demonstrated a decreased risk for nonsurgical readmission. Further prospective trials are needed to better delineate optimal route of antibiotic administration in patients with penetrating CD.

Impact of antibiotic allergy labels on timely and appropriate antibiotics for sepsis in the emergency department

Abstract Objectives Time to initiation of effective antibiotic therapy is a strong predictor of survival for patients with sepsis presenting to the Emergency Department (ED). Antibiotic allergy labels (AALs) are a known barrier to timely sepsis management. The aim was to evaluate the influence of AALs on timely sepsis management for ED sepsis presentations in an Australian hospital. Methods A retrospective cohort study was conducted for ED presentations requiring direct ICU admission for suspected sepsis, comparing patients with and without an AAL using propensity scores. Results Between November 2018 and June 2021, 377 patients were included. The prevalence of an AAL was 29.6% (86/377). The median time to antibiotic administration was similar in the AAL versus non-AAL groups (51 versus 60 min, P = 0.11); there was no difference in mortality (14.1% versus 14.0%, P = 0.98) and length of stay (9.21 versus 10.10 days). The median time to antibiotic administration was shorter in those with Emergency Medicine (EM) pharmacist attendance versus those without (50 versus 92 min, P = 0.0001). Appropriateness of antibiotic prescription was 91.0% (343/377) for the overall cohort and was not associated with AALs, possibly due to our clear antimicrobial sepsis guidelines; however, EM pharmacist involvement was associated with increased antibiotic appropriateness (97.3% versus 88.4%, P = 0.00048). Conclusions In our Australian ED, AALs were not found to impact timeliness of antibiotic administration in patients with sepsis. EM pharmacist involvement was associated with improved timeliness and appropriateness of antibiotic selection in patients presenting with sepsis.

Preoperative oral antibiotic administration in patients undergoing curative resection with stoma creation for colorectal cancer: effectiveness in preventing surgical site infection and the possibility of peristomal candidiasis induced by enterobacterial alteration.

There are many reports that preoperative oral antibiotics (OAs) are effective in preventing surgical site infections (SSIs) in colorectal surgery. However, there is no consensus on the optimal dose of OAs. In this study, we investigated the efficacy of OAs in preventing SSIs and the possibility that OAs induce enterobacterial alteration in the intestinal tract. We performed a retrospective cross-sectional analysis of 389 patients who underwent R0 resection and stoma creation for colorectal cancer in our department between 2009 and 2020. We focused on the incidence of peristomal candidiasis (PSC) as an indicator of enterobacterial alteration and used kanamycin (KM) and metronidazole (MNZ) as the OAs. A low-dose group received 1000 mg/day of both KM and MNZ, and a high-dose group received 2000 mg/day of both KM and MNZ. SSI occurred in 60 of the 389 cases (15.4%). Regardless of stoma type, SSI was significantly more common in the non-OA group, while PSC was significantly less common. When examined by OA dose, the incidence of SSI was not significantly different between the low-dose and high-dose groups. However, PSC was significantly more common in the high-dose group than in the non-OA and low-dose groups. Analysis of bacterial and fungal levels in stool samples showed that bacterial levels after OAs were significantly lower than before OAs, while fungal levels increased. OAs significantly reduce SSI in colorectal cancer surgery. However, excess OAs were significantly associated with the occurrence of PSC without contributing to further reduction in SSI.

Patterns of antibiotic administration in patients with burn injuries: A TriNetX study

BackgroundIn the advent of increasing antibiotic resistance, several studies sought to determine antibiotic prescription trends; however, no pattern has been firmly identified particularly for the burned population. We performed a query of burned patients in a large established database to understand differences in antibiotic use related to patient-specific factors. MethodsBurned patients with systemic antibiotics given within 7 days of injury were identified on the TriNetX database. The patient population was stratified by age, 1-year time intervals of antibiotic prescription from 2004 to 2019, time of antibiotic prescription in 1-day intervals after injury, and % TBSA burned in 10% intervals ranging from < 10% to > 90%. Data were analyzed using χ2 with p < 0.05 considered significant. Pearson coefficients (r2) values were used to correlate differences in antibiotic prescription between age groups and to changes over time. ResultsStratification by age revealed higher use of antibiotics in older burned patients compared to younger patients. Surprisingly, 87.6% of burn patients of those who received antibiotic therapy was on the day of injury. Penicillins and beta-lactam antimicrobials were used most often at a frequency of 64%. No statistically significant differences in rates of antibiotic therapy were observed in burned patients when stratified by %TBSA burned. ConclusionsThe study elucidates current patterns of antibiotic use in burn care in the United States, allowing for improved understanding of both past and present patterns of antibiotic prescription.

Outcome of an elective readmission policy in patients receiving acute myeloid leukaemia consolidation therapy and implications for an outpatient management programme.

Safe outpatient management of acute leukaemia consolidation cycles may enable substantial savings in admission costs. Safety involves the prompt administration of antibiotics in patients with neutropenic fever. Our unit in a metropolitan tertiary referral hospital analysed a cohort of patients spanning a 10-year period, with two key observations: (i) a high proportion of patients living a substantial distance from hospital and (ii) the high incidence and generally prompt onset of fever after severe neutropenia, suggesting this broad applicability of this approach is unfeasible without addressing travel issues and potentially reducing and/or delaying neutropenic fever with prophylactic antibiotics.

The challenges of diagnosis and treatment of rare Prevotella-induced breast abscesses: A retrospective cohort study

ObjectiveAlthough the genus Prevotella is part of the general human microbiota, species of this anaerobic gram-negative bacterium have been described as causes of persisting nonpuerperal breast abscesses. Collecting punctate samples and testing these samples for anaerobic bacteria is not part of the common diagnostic workflow in atypical breast abscesses. The causative anaerobic micro-organism can remain unclear and patients can be treated with multiple inadequate antibiotics and/or extensive surgical procedures. The aim of this cohort study of Prevotella induced breast abscesses is to gain more insights into the diagnostic procedures and treatment. MethodsMedical charts of patients with a Prevotella induced breast abscess between 2015 and 2021, were retrospectively reviewed on patient characteristics, diagnostic procedures, treatment and outcome. ResultsTwenty-one patients were included. Six subspecies of Prevotella were determined by culturing. High susceptibility was observed for amoxicillin/clavulanic acid (100%, n = 12). Nine patients (43%) were treated with antibiotics, eight patients (38%) with antibiotics and incision and drainage, and four patients (19%) with only incision and drainage. Recurrence was observed in nine patients (43%), of whom five patients were treated with antibiotics and three patients had surgery. The mean duration of antibiotic administration in patients with recurrence was significantly shorter compared to those without recurrence (5.6 days vs. 19.5 days, p = 0.039). ConclusionSpecific anaerobic culturing should be common practice in atypical breast abscesses to confirm Prevotella species. The high recurrence rate emphasizes the need of further research for optimal treatment. Prolonged duration of antibiotics could be considered and amoxicillin/clavulanic acid seems to be the first choice.

Molecular technique for precise antibiotics administration in patients with cancer.

e18749 Background: Infectious diseases are the second most common cause of mortality in oncology patients. Multiple hospital admissions and previous exposure to antibiotics are risk factors for infection with microorganisms having antibiotic resistance gene in these patients.Molecular technique helps in targeted antibiotic administration at the earliest. Methods: This was a retrospective observational study over a period of one year from November 2021 to October 2022 in Tata Memorial Hospital, Mumbai, on oncology patients with blood stream infection (BSI) whose blood sample underwent film array assay. The BioFire Blood culture Identification 2 Panel (BCID2) which identifies Imipenemases (IMP), Klebsiella pneumoniae carbapenemases (KPC), New Delhi metallo beta-lactamases (NDM), oxacillinase-48 like (OXA-48), Verona integron-encoded metallo beta-lactamase (VIM), CTX M and methicillin resistance gene like mec A/C was used. BSI was categorised according to the resistance gene and recommended antibiotics of choice as per the Infectious Disease Society of America (IDSA). CTX-M - Carbapenem&amp;nbsp; OXA-48 like/ KPC - Ceftazidime-avibactam, Polymixin&amp;nbsp; Metallo beta-lactamase (MBL) i.e VIM, IMP, NDM - Ceftazidime-avibactam plus aztreonam, polymyxin, Cefiderocol&amp;nbsp; The impact of appropriate antibiotic administration on 30-day mortality was seen. Results: A total of 79 blood samples were submitted for film array assay during the study period. The mean age of the study population was 17± 4 years. 41(51.9%) patients had acute myeloid leukemia (AML), 29 (36.7%) had acute lymphocytic leukemia (ALL), 4 (5%) patients had lymphoma and 5 (6.3%) had other malignancies. 54(68.3%) BSI had microorganism with antibiotic resistance gene, 16 (20.3%) did not carry resistance gene and in 9 (11.4%), microorganism was not identified in film array assay, though conventional culture showed contaminants. Of the 54 BSI with microorganisms having antibiotic resistance gene, 37(68.5%) had MBL gene either alone or along with CTX-M or OXA-48 like genes, 12 (22.2%) had CTX-M and 5 (9.2%) had both CTX-M and OXA -48 like genes. Empirical antibiotic did not match the antibiotic resistance pattern in 40 (74.1%), antibiotic matched the resistance pattern in 14(22.9%). Antibiotic adjustment was done in 32 (86%) of MBL, 4 (80%) of OXA-48 like with CTX-M and 9 (75%) CTX-M. The 30-day mortality was significantly less (28% vs 80%, p = 0.042) in patients who received appropriate antibiotic versus those who continued inappropriate antibiotics in MBL BSI. Conclusions: Majority of the study population had BSI with antibiotic resistance gene and underwent a change in the antibiotic after the assay. There was lesser 30-day mortality in patients who received antibiotics appropriate for the identified resistance gene. Molecular technique is helpful for precise antibiotic administration in cancer patients who have a higher risk of infection with organisms having resistance gene.

Severe drug eruption after antibiotic administration in patients receiving immune checkpoint inhibitors: A monocentric case series

AbstractImmune checkpoint inhibitor (ICI) therapy is often associated with cutaneous immune‐related adverse events (irAEs). Drug eruptions stemming from concomitantly or consecutively administered medications are also frequent and tend to be severe. We herein present three cases of severe drug eruption in patients receiving antibiotics during ICI therapy in which hypotensive shock occurring during antibiotic administration was followed by generalized erythema and prolonged organ damage. Three patients received tazobactam/piperacillin (TAZ/PIPC) for an infection during ICI treatment. A high fever developed in all the patients after a switch was made to other antibiotics (Figures 2–4). Since no skin rash was observed at fever onset, a flare‐up of the infection was suspected, and TAZ/PIPC administration was resumed. Thereafter, the patients suddenly experienced hypotensive shock and respiratory failure requiring ICU management for generalized erythema and organ damage. Since anaphylaxis caused by TAZ/PIPC is rare, the patients’ clinical findings might be a manifestation of synergistic, complementary, immunomodulatory effects of ICI. In patients receiving ICI therapy, a fever occurring during antibiotic administration may indicate the onset of an immune hypersensitivity reaction to the drug. Resumption of antibiotic administration, especially TAZ/PIPC, during such a period may trigger an excessive inflammatory response, leading to an anaphylaxis‐like reaction and organ damage.

Efficacy of lymphotropic parenteral antibacterial therapy in patients with an acute pancreatitis

Objective.To compare clinical results of application of lymphotropic antibacterial therapy (LATH) versus standard method of parenteral administration of antibiotics in patients, suffering an acute pancreatitis.&#x0D; Materials and methods. Clinical data, the values of the leucocyte and hematological intoxication indices, and some other indices of immunity, occurring on background of lymphotropic and standard antibacterial therapy, were studied. The patients were distributed into two groups: Group I (the main) - to whom lymphotropic antibioticotherapy was conducted, and Group II (a control one) - to whom a standard antibioticotherapy was applied.&#x0D; Results. In patients of the main group the pain syndrome, belching and regurgitation have had regressed during 2 days of treatment. During 5 days of treatment the intoxication signs have been eliminated. In the patients, admitted to hospital in the first day of an acute pancreatitis manifestation, the values of the intoxication leucocytes index after 5 days of the LATH conduction were on the level of corresponding index of practically healthy people, the CD3 and CD4 quantity raised statistically significantly, and the dimensions of the inflammatory changed pancreatic gland reduced.&#x0D; Conclusion. Lymphotropic injection of antibiotics and anti-inflammatory medicines promotes inhibition of inflammatory process in pancreatic gland. On background of adverse development of inflammation, a more rapid improvement of clinical symptoms of an acute pancreatitis, as well as in the indices of the common markers of inflammatory process and cellular immune defense, are observed. The data obtained witness the advantage of LATH over a standard (parenteral) one in the treatment of an acute pancreatitis.

Evaluation of the impact of a pharmacist-run antimicrobial report in reducing delays in subsequent antibiotic administration in patients in the emergency department.

To determine whether the implementation of a pharmacist-run, real-time electronic health record (EHR) antimicrobial report reduces the frequency of delays in subsequent antibiotic medication administration timing in patients in the emergency department (ED). A single-center, retrospective, pre-and-post quasi-experimental study was conducted between July and December 2021 following the implementation of an antimicrobial EHR report of adult patients presenting to the ED who were continued on antibiotic therapy after receiving a one-time dose of an antibiotic in the ED. The primary objective was to determine the impact of the pharmacist-run, real-time EHR antibiotic dosing report in the ED on reducing the number of major delays in subsequent antibiotic administration times. A subanalysis of the primary outcome was performed to evaluate differences in major delays based on specific dosing intervals of 6, 8, and 12 hours. A total of 521 subsequent antibiotic dosing orders from 273 patient encounters were analyzed, with major delays in subsequent antibiotic dosing administration times identified in 20% of the intervention group compared to 27% of the control group (P = 0.047). Major delays were also significantly decreased in the intervention group compared to the control group for antibiotics dosed at 8-hour intervals (18% vs 32%; P = 0.026). No significant difference in delays was observed between the groups for antibiotics dosed at 6-hour intervals (18% vs 27%) or 12-hour intervals (29% vs 21%). Implementing a real-time EHR antimicrobial report run by pharmacists in the ED was associated with significantly fewer major delays in subsequent antibiotic dosing following a first dose.

Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis

IntroductionUnderstanding the proportion of patients with COVID-19 who have respiratory bacterial co-infections and the responsible pathogens is important for managing COVID-19 effectively while ensuring responsible antibiotic use.ObjectiveTo estimate the frequency of bacterial co-infection in COVID-19 hospitalized patients and of antibiotic prescribing during the early pandemic period and to appraise the use of antibiotic stewardship criteria.MethodsSystematic review and meta-analysis was performed using major databases up to May 5, 2021. We included studies that reported proportion/prevalence of bacterial co-infection in hospitalized COVID-19 patients and use of antibiotics. Where available, data on duration and type of antibiotics, adverse events, and any information about antibiotic stewardship policies were also collected.ResultsWe retrieved 6,798 studies and included 85 studies with data from more than 30,000 patients. The overall prevalence of bacterial co-infection was 11% (95% CI 8% to 16%; 70 studies). When only confirmed bacterial co-infections were included the prevalence was 4% (95% CI 3% to 6%; 20 studies). Overall antibiotic use was 60% (95% CI 52% to 68%; 52 studies). Empirical antibiotic use rate was 62% (95% CI 55% to 69%; 11 studies). Few studies described criteria for stopping antibiotics.ConclusionThere is currently insufficient evidence to support widespread empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection is low. Furthermore, as the use of antibiotics during the study period appears to have been largely empirical, clinical guidelines to promote and support more targeted administration of antibiotics in patients admitted to hospital with COVID-19 are required.

Comparison between culture-positive and culture-negative septic shock in patients in the emergency department.

Culture results of patients with septic shock affect their management strategies, including antibiotic administration. This study aimed to compare clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in the emergency department. We also assessed the differences in duration and de-escalation timing of antibiotic administration between the two groups. This single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into the CNSS and CPSS groups based on their culture results. The baseline characteristics, infection sites, culture types, and clinical outcomes were recorded and compared. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), 30-day mortality (35.7% vs. 36.7%, p = 0.82), and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The CNSS group had a significantly shorter duration (13 [8 - 19] vs. 16 [10 - 23], days, p = 0.04) and earlier de-escalation timing (5 [2 - 9] vs. 9 [7 - 12], day, p = 0.02) of antibiotic administration than the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and proportion of adverse outcomes. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in patients with CNSS showing clinical improvement.

Outcomes after early versus delayed antibiotic treatment of liver abscess in Japan: A nationwide retrospective cohort study

BackgroundThe optimal timing of antibiotic administration in patients with a liver abscess undergoing liver aspiration or drainage is unknown. MethodsThis was a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database in Japan. ResultsA total of 34,424 patients who were emergently hospitalized due to liver abscess between July 2010 and March 2020 were included. Of these, 31,248 (90.8%) received antibiotics on the day of admission (early antibiotics group), and 3176 (9.2%) did not (delayed antibiotics group). Multivariable logistic regression analyses showed that in-hospital mortality of patients in the early antibiotics group was significantly lower than that in the delayed antibiotics group (odds ratio, 0.61; 95% confidence interval, 0.52–0.72; p <0.001). Patients in the early antibiotics group had a significantly lower proportion of clinical deterioration (odds ratio, 0.73; 95% confidence interval, 0.63–0.84; p <0.001) and shorter length of stay (adjusted difference, −5.2 days; 95% confidence interval, −6.2 to −4.1 days; p <0.001) than those in the delayed antibiotics group. ConclusionsStarting antibiotic treatment on the day of admission was associated with lower mortality, a lower proportion of clinical deterioration, and a shorter length of hospital stay.

479 Closed Loop Quality Improvement Project Improving Time to Peripherally Inserted Central Catheters (PICCs) and Intravenous (IV) Antibiotic Administration in Patients with Complex Orthopaedic Infections

Abstract Aim Bone, joint and soft tissue infections often require long term antibiotic therapy. Reliable IV access is essential for IV antibiotic administration and monitoring. PICCs provide consistent, long-term IV access. Aim: improve time to PICC request, insertion, and reduce issues with poor IV access in patients requiring long term IV antibiotics. Method Standard audit protocol. Data tool was developed and tested. Data was collected retrospectively from departmental database and online records for all patients admitted with suspected bone, joint or soft tissues infection from 01/11/19–29/2/20. Department policy and induction programme were updated. Cycle 2 included all patients from 1/8/20–30/11/21. Results Cycle 1 included 91 patients. 30 PICCs were requested with 26 inserted. Mean time to PICC request from diagnosis was 8.7 days(1–33). Mean time to PICC from request was 6.7 days(1–15). Mean time to PICC from diagnosis was 15.9 days(4–39). 10 of 30(33.3%) patients missed antibiotics due to lack of IV access. Cycle 2 included 156 patients. 36 PICCs were requested with 18 inserted. Mean time from diagnosis to request was 4.4 days(1–15). Mean time from request to insertion was 4.2(1–8) days. Mean time from diagnosis to insertion was 8.6 days(1–21). Missed IV antibiotics were reduced from 33.3% to 15.4%. Conclusions Time to PICC insertion was improved through education and introduction of new policy at departmental induction. This low-cost change can significantly improve both treatment and patient experience when admitted for complex orthopaedic infection through reliable antibiotic administration and reducing the number of IV access attempts.

Association between the timing of antibiotics administration and outcome of neonatal sepsis

BackgroundSepsis is a life-threatening condition that requires aggressive and rapid intervention. However, data on the association between antibiotic administration timing in neonatal sepsis and neonatal outcomes is limited, particularly in the gulf area. ObjectiveThis study aimed to evaluate the association between the timing of antibiotic administration and the outcome of neonatal sepsis. Design and settingThis retrospective comparative study was conducted through data collection from medical records of patients with neonatal sepsis. The patients were categorized into two groups based on the time interval between antibiotic prescription and drug administration: non-delayed group consisted of patients who received antibiotics within 3 h and the delayed group consisted of those who received antibiotics after 3 h. ResultsA total of 237 neonates diagnosed with sepsis were included, of which 9.3% had necrotizing enterocolitis, 35% had bronchopulmonary dysplasia, and 6.3% had maternal chorioamnionitis. Additionally, 18.6% of the neonates’ mothers were prescribed with antibiotics during labor, and 5.5% had maternal fever. Staphylococcus epidermidis was the most commonly isolated strain (24.1%). Of the total neonates, 87.3% received antibiotics within the first 3 h from the prescription. Survival rate was significantly higher and the risk of complications such as necrotizing enterocolitis, and bronchopulmonary dysplasia was significantly lower in the non-delayed group. Moreover, the length of hospital stay was significantly shorter in the non-delayed group. ConclusionEarly antibiotic administration in patients with neonatal sepsis can improve the survival rate and reduce the incidence of complications.

Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis; Less May Be More.

Administration of antibiotics in patients with cirrhosis and upper gastrointestinal bleeding has been shown to improve outcomes. Little is known regarding optimum duration of prophylactic antibiotics. Seven days of antibiotics are generally recommended but very few studies have compared antibiotic duration to clinical outcomes in current available scientific literature. The goal of our study was to study the effect of shorter antibiotic duration on patient outcomes. We conducted a retrospective cohort study of patients with cirrhosis presenting with upper GI bleeding at our institute from 2010 to 2018. Patients were divided into three cohorts based on duration of antibiotic administration for prophylaxis: 1-3days of antibiotics, 4-6days of antibiotics and 7days or more of antibiotics. Rates of infection diagnosis within 30days, rebleeding, and mortality were compared between the three groups with Chi square, Fisher Exact and Kruskall-Wallace tests. Multivariable analysis was conducted to evaluate independent risk factors for infection. Medical charts of 980 patients with cirrhosis and upper GI bleeding during the study period were reviewed. A total of 303 with upper gastrointestinal bleeding were included in the final sample, of these 243 patients received antibiotics for prophylaxis and were included for analysis. Seventy-seven patients received antibiotic therapy for 3days or less, 69 patients for 4-6days, and 97 patients longer than 6days. The three groups were well matched in demographic and clinical variables. Twenty-seven patients developed infections within 30days of bleeding. MELD-Na score at presentation and presence of ascites were associated with infection within 30days. Rates of infection were not statistically different between the three antibiotic groups (p = 0.78). In the thirty days following the GI bleed, pneumonia was the most diagnosed infection (eleven patients) followed by urinary tract infections (eight patients). Four patients developed spontaneous bacterial peritonitis and three were diagnosed with bacteremia. There was no difference in time to infection (Kruskall Wallace test p = 0.75), early re-bleeding (p = 0.81), late re-bleeding (p = 0.37) and in-hospital mortality (p = 0.94) in the three groups. Six patients in the cohort developed C. Difficile infection; no patient in the short antibiotic group developed C. Difficile infection. Short course of antibiotics for prophylaxis (3days) appears safe and adequate for prophylaxis in patients with cirrhosis with upper gastrointestinal bleeding if there is no active infection.

P27 Bacterial coinfection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis

IntroductionUnderstanding the proportion of patients with COVID-19 who have respiratory bacterial coinfections and the responsible pathogens is important to managing COVID-19 effectively while ensuring responsible antibiotic use.ObjectivesTo estimate the frequency of bacterial coinfection in COVID-19 patients and of antibiotic prescribing and to appraise the use of antibiotic stewardship criteria.MethodsSystematic review and meta-analysis was performed using major databases up to May 15, 2020. We included studies that reported a) proportion/prevalence of bacterial coinfection in COVID-19 patients and b) use of antibiotics. Where available, data on duration and type of antibiotics, adverse events, and any information about antibiotic stewardship policies were also collected.ResultsWe included 39 studies with a total of 10 815 patients. The overall prevalence of bacterial coinfection was 10.6% (95% CI 6.8%–14.3%). When only confirmed bacterial coinfections were included the prevalence was 4.6% (95% CI 2.9%–7%). Thirty-five bacterial species were identified, the most frequent being Mycoplasma pneumoniae (n = 12 [34%]), Pseudomonas aeruginosa (n = 4 [11.4%]) and Legionella pneumophila (n = 2 [6%]). The overall antibiotic use was 71.3% (95% CI 63.1%–79.5%). Only one study described criteria for stopping them. All included studies had a moderate to high risk of bias.ConclusionsThere is currently insufficient evidence to support widespread empirical use of antibiotics in most hospitalized patients with COVID-19, as the overall proportion of bacterial coinfection is low. Furthermore, as the use of antibiotics appears currently to be largely empirical, it is necessary to formulate clinical guidelines to promote and support more targeted administration of antibiotics in patients admitted to hospital with COVID-19.

An observational study on the use of long acting buprenorphine (Sublocade) and a Tamper resistant PICC for Outpatient IV antibiotic administration in Patients with serious infections and Opioid Use Disorder; The STOP OUD project

What is STOP OUD?The STOP OUD project is an observational study on the use of long-acting buprenorphine (Sublocade) and a Tamper resistant PICC clamp for Outpatient IV antibiotic administration in Patients with serious infections and Opioid Use Disorder (STOP OUD). BackgroundThe US opioid crisis is driving up serious infections related to intravenous drug use. These infections require prolonged courses of antibiotics, often resulting in lengthy hospital stays. Extended hospitalizations for monitored parenteral antibiotics for patients with opioid use disorder are challenging for patients, reduce bed capacity, and are associated with significant cost. This observational study reviews the administration of intravenous (IV) antibiotics in a monitored outpatient setting using long-acting injectable buprenorphine (Sublocade, Indivior Inc., North Chesterfield, VA) and a tamper resistant clamp in patients with opioid use disorder . MethodsLong-acting buprenorphine and a tamper resistant clamp were used to treat patients with serious infections and opioid use disorder as outpatients. ResultsHospital days avoided were 30-days per STOP OUD project participant. Eleven of thirteen STOP OUD project participants completed their antibiotic courses as prescribed, there was no evidence of peripherally inserted central catheter (PICC) tampering, and they rated their care as a mean of 4.9/5 (SD 0.4). Institutional savings per STOP OUD patient was $33,000. Outpatient infusion costs were $9,300 for a net savings of $23,700 per STOP OUD project participant. Infections resolved in all participants. ConclusionsThe STOP OUD project reduced hospital length of stay for patients with opioid use disorder and serious infections, and had a favorable financial impact.

Pharmacist driven antibiotic redosing in the emergency department

Determine whether an expanded emergency medicine (EM) pharmacist scope of practice reduces the frequency of major delays in subsequent antibiotic administration in patients boarded in the emergency department (ED). A pre-post, quasi-experimental study conducted from November 2019-March 2020 at a single-center tertiary academic medical center following the implementation of an expanded EM pharmacist scope of practice. Adult patients were included if they received an initial antibiotic dose in the ED and deemed to be high-risk. Subsequent antibiotic doses were reordered by EM pharmacists for up to 24-h after the initial order pending ED length of stay (LOS). The historical control group consisted of retrospective chart review of cases from the previous year. The study identified that of the 181 participants enrolled, major delays in subsequent antibiotic administration occurred in 13% of the intervention group and 48% of the control group (p < 0.01). When compared to the control group, the intervention group had a significant decrease in the number of delays among antibiotics dosed at 6-h (39% vs 13%) and 8-h (60% vs 8%) intervals. For antibiotics dosed at 12-h intervals, no statistically significant difference was observed between the control and intervention groups respectively (19% vs 5%). A statistically significant lower incidence of in-hospital mortality was observed in the intervention group (3% vs 11%, p = 0.02). In the intervention group, 97% of patients received subsequent antibiotic doses while boarded in the ED, compared to 65% in the control group (<0.01). Expanding EM pharmacist scope of practice was associated with a significant reduction in the frequency of major delays in subsequent antibiotic administration as well as a decreased incidence of hospital mortality.