Infectious Disease Physicians Research Articles

The effectiveness of the appropriate prophylactic antibiotic use program for surgery

Background: Evaluation of the adequacy of prophylactic antibiotics in surgery has been implemented as a national policy in Korea since August 2007, and the appropriate use of prophylactic antibiotics has improved. However, antibiotic prescriptions that are not recommended or discontinuation of prophylactic antibiotic administration within 24 hours after surgery are still not well done. This study introduced a program to improve the adequacy of prophylactic antibiotics for surgery and analyzed its effects. Methods: We retrospectively analyzed the effectiveness of the appropriate prophylactic antibiotic use program for surgery conducted at a university hospital in Seoul. The participants were patients aged ≥18 years who underwent any of 18 types of surgery. The program started was implemented in June 2020. First, a computer system was used to confirm the antibiotic prescription recommended for each surgery. It also assessed whether the number of days of administration was exceeded, whether antibiotics were prescribed in combination, and whether antibiotics prescribed for discharge medicine were checked in 4 steps. A pop-up window appeared in each patient record to enter the reason for the prescription. If the reason was appropriate, the prescription was allowed, but if not, the prescription was restricted. In addition, infectious diseases physicians and an insurance review team visited each department to conduct an education session. To analyze the effect 3 months before activity (January–March 2020) and 3 months after activity (October–December 2020), we compared the first antibiotic administration rate within 1 hour prior to skin incision, the recommended prophylactic antibiotic administration rate, and surgery type. The rate of discontinuation of prophylactic antibiotics within 24 hours after administration and the rate of prescription of prophylactic antibiotics at discharge were compared. Results: In total, 1,339 surgeries during the study period were included in the analysis. There were 695 cases before the introduction of the program and 644 cases after the introduction. The rate of first antibiotic use within 1 hour prior to skin incision was 93.1%–99.5% (P < .001), the rate of recommended prophylactic antibiotic administration was 85.0%–99.2% (P < .001), and the rate of discontinuation of antibiotic administration within 24 hours after surgery improved from 51.8% to 98.3% (P < .001), respectively. The prescription rate of antibiotics at discharge improved from 20.7% to 0.8% (P <.001) (Table 1). Conclusions: A computerized program to improve the adequacy of prophylactic antibiotic use in surgery combined with education of medical staff was very effective.Disclosure: None

The Current Policy Debate around the Regulation of LDTs: What It Means for Infectious Disease Testing and Where It May Be Headed

The debate over federal regulation of diagnostic tests is not new, but scientific advances, societal developments, and global events over the past decade have accelerated efforts by the Food and Drug Administration (FDA) and members of Congress to revise the regulatory oversight of these devices, including laboratory-developed tests (LDTs). Despite years of congressional hearings and public meetings, legislation in the House and Senate, draft guidance from the FDA, and debate in the stakeholder community, LDT regulation remains unchanged, and the path forward remains unclear. LDTs play an essential role in infectious disease (ID) management and treatment, and changes in their regulation will have far-reaching implications for diagnostic laboratories. LDTs are widely used by clinical microbiology laboratories for the diagnosis and monitoring of a myriad infectious diseases, and until three years ago, such testing was conducted largely out of the spotlight. The COVID-19 pandemic changed this by bringing ID tests into the forefront. As the 118th Congress gets under way, the regulation and oversight of diagnostic tests, including LDTs, remains at the forefront of health care policy discussions on Capitol Hill and with the FDA. Change is coming, and it is important that clinical microbiologists, ID physicians, and other laboratorians have a seat at the table when such changes are being discussed.

Learning what matters in allogeneic transplant: Insights into older patient preferences in an age-friendly multidisciplinary clinic.

e24029 Background: HCT is increasingly being considered for older adults (60+) with blood cancers, with emerging data suggesting HCT imparts a survival benefit for eligible patients (pts). HCT-related morbidity and mortality remains significant in older adults, with no consensus on how to best prospectively evaluate HCT versus other approaches. Shared decision making (SDM) may help reconcile such treatment options for older adults. Understanding pts preferences (PP) and values is a cornerstone of SDM, yet no data exist in how to elicit and apply PP for older adults facing this treatment choice. Methods: We analyzed documented PP among the first 40 older adults from an ongoing IRB-approved prospective protocol enrolling HCT candidates ≥60 years to participate in a multi-disciplinary optimization clinic, the Aging & Blood Cancers (ABC) clinic. The ABC clinic is comprised of pre-HCT consultations with a geriatrician, HCT physician, physical therapist, dietician and social worker and an ID physician. We reviewed the primary treating team documentation relative to the ABC clinic documentation, notes reviewed from HLA typing orders or documented plan for HCT. Categorization of PP consisted of any of the following: (1) care goals after HCT (e.g. cure, disease control, functional recovery, spending time with family/friends, attending life events), (2) toxicity concerns, and (3) pt rationale for proceeding to HCT. We included PP when summarized in the advanced care planning (ACP) documents if signed by a team member or referenced in their note. Findings were extracted by one physician and then reviewed by a second physician to adjudicate assignment as a PP. P-values were derived from incidence rates and chi-squared testing. Results: Among 40 pts with a median age of 74 yrs (range 60-), 856 notes and 38 ACP documents were reviewed. We found PP in 26 notes (2.9%) in 19 pts (47.5%). Of pts with PP documented, the primary team accounted for 4, compared to 14 pts in the ABC clinic (p < 0.02). Notably, the primary team documented a risk:benefit discussion about HCT in 31 patients (p < 0.0001). Among total PP (n = 19) the most common included functional recovery (73.6%), spending time with family or specific people (73.6%) and minimizing toxicity (42.1%). Less common PP were disease control/cure (31.6%) or avoiding the need for future disease treatments (15.8%). Conclusions: To our knowledge, this is the first study to document older adult PPs before HCT, finding them to be rarely documented. The older adult specific HCT clinic enhanced preference documentation, yet still in less than half of pts. Future studies to develop tools to better elicit and incorporate pt preferences should be prioritized to facilitate shared decision making for HCT among older adults.

Variations in implementation of antimicrobial stewardship via telehealth at select Veterans Affairs medical centers

Background: Antimicrobial stewardship programs (ASPs) seek to reduce the prevalence of antimicrobial-resistant and healthcare-associated infections. There are limited infectious disease (ID) physicians and pharmacists to support these ASPs, particularly in rural areas. The Veterans Health Administration has a robust telehealth program in place. Our previous work has demonstrated the feasibility of using telehealth modalities to support ASPs at rural Veterans Affairs medical centers (VAMCs) by pairing them with an ID expert from a larger, geographically distant, VAMC. This program, dubbed the Videoconference Antimicrobial Stewardship Team (VAST), emphasizes discussion of patients undergoing treatment for an active infection and additional relevant clinical topics with a multidisciplinary team at the rural VA. VAST implementation is ongoing at VAMCs. To understand and compare the qualitative differences in implementation, we used process maps to describe the VAST at 3 VAMC dyads. Methods: Team members from each dyad participated in interviews at 3, 6, and 9 months after beginning their VAST sessions. Questions addressed several aspects of VAST implementation and included identifying cases and topics to discuss; advance preparation for meetings; the frequency and general structure of VAST meetings; and documentation including workload capture. The research team used the responses to develop process maps to permit visual display and comparison of VAST implementation. Results: The first dyad began in January 2022 and the third in March 2022. The sessions had 3 phases: preparation, team meeting, and documentation of experts’ recommendations. Tasks were shared between VAST champions at the rural VAMC and the ID experts (Fig. 1). The preparation phase showed the most variation among the 3 dyads. In general, champions at the rural VA identified cases and topics for discussion that were sent to the ID expert for review. The approaches used to find cases and the type of preparatory work by the ID expert differed. Team meetings differed in both frequency and participation by professionals from the rural site. Documentation of expert recommendations processes appeared similar among the dyads. Discussion: Each of the 3 dyads implemented VAST differently. These results suggest that the overall structure of the VAST is readily adaptable and that each site tailored VAST to suit the clinical needs, workflow, and culture of their partner facility. Future work will seek to determine which aspects in the preparation, team meeting, or documentation phases are associated with successful ASPs, including assessment of quantitative and qualitative outcomes.Disclosures: None

The impact of a blood-culture diagnostic stewardship intervention on utilization rates and antimicrobial stewardship

Background: Blood cultures are often ordered when an infection is suspected; however, they have a low yield in most cases. The overuse of blood culture is associated with high contamination rates, resulting in excess diagnostics, unnecessary antibiotics, longer hospital stays, and higher hospital costs. We evaluated the safety of a multifaceted intervention, which encompassed education and blood-culture restriction, and its impact on blood-culture utilization and antibiotic use in adult intensive care unit (ICU) patients. Methods: The study was performed between October 2020 and October 2021 in the 12 general medicine and specialty ICUs of a quaternary academic care center. The intervention, implemented in April 2021, included providing education to ICU and infectious disease physicians based on an algorithm adapted from the Johns Hopkins DISTRIBUTE study in addition to restricting blood-culture ordering on these units to these providers. The month of April 2021 was excluded as a washout period. Study outcomes comprised blood-culture utilization, blood-culture positivity, days of therapy (DOT), and length of therapy (LOT), which were compared across the study periods using IRR or the Pearson χ2 test, as appropriate. In addition, 30-day mortality and 30-day ICU readmission were evaluated utilizing multiple COX regression models. Results: In total, 6,303 patients (2,087 MICU, 3,636 SICU, and 580 both) were included in the study, with a median age of 65 years (IQR, 21). Most participants were male (57.5%), with a median length of stay of 175 hours (IQR, 186). After the intervention, blood-culture utilization rates decreased from 15.4% to 12.4% (IRR 0.80, 95% CI, 0.76–0.85) (Fig. 1). There was no difference in blood-culture positivity between the preintervention period (11.05%) and the postintervention period (11.64%; P = .459). Days of therapy decreased from 1,180 to 1,130 per 1,000 patient days (IRR, 0.96; 95% CI, 0.95–0.98), and the length of therapy decreased from 602 to 579 per 1,000 patient days (IRR, 0.96; 95% CI, 0.94–0.99) (Fig. 2). There was no difference in 30-day mortality (P = .241) nor 30-day ICU readmission (P = .888) across the study periods after adjusting for potential confounders (Table 1). Conclusions: Our multifaceted intervention decreased blood-culture and antimicrobial utilization in the ICUs without significantly affecting the positivity rate, mortality, or readmission. This study suggests that educating providers on appropriate blood-culture use along with restriction could safely improve healthcare outcomes. Further studies are warranted to validate our results across various institutions and to evaluate the impact of blood-culture optimization in non-ICU patients.Disclosures: None

Use of contact precautions for multidrug-resistant organisms and the impact of the COVID-19 pandemic: An Emerging Infections Network (EIN) survey

Background: The CDC recommends routine use of contact precautions for patients infected or colonized with multidrug-resistant organisms (MDROs). There is variability in implementation of and adherence to this recommendation, which we hypothesized may have been exacerbated by the COVID-19 pandemic. Methods: In September 2022, we emailed an 8-question survey to Emerging Infections Network (EIN) physician members with infection prevention and hospital epidemiology responsibilities. The survey asked about the respondent’s primary hospital’s recommendations on transmission-based precautions, adjunctive measures to reduce MDRO transmission, and changes that occurred during the COVID-19 pandemic. We sent 2 reminder emails over a 1-month period. We used descriptive statistics to summarize the data and to compare results to a similar EIN survey (n = 336) administered in 2014 (Russell D, et al. doi:10.1017/ice.2015.246). Results: Of 708 EIN members, 283 (40%) responded to the survey, and 201 were involved in infection prevention. Most respondents were adult infectious diseases physicians (n = 228, 80%) with at least 15 years of experience (n = 174, 63%). Respondents were well distributed among community, academic, and nonuniversity teaching facilities (Table 1). Most respondents reported that their facility routinely used CP for methicillin-resistant Staphylococcus aureus (MRSA, 66%) and vancomycin-resistant Enterococcus (VRE, 69%), compared to 93% and 92% respectively, in the 2014 survey. Nearly all (>90%) reported using contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter spp, but there was variability in the use of contact precautions for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase–producing gram-negative organisms. In 2014, 81% reported that their hospital performed active surveillance testing for MRSA, and in 2022 this rate fell to 54% (Table 2). The duration of contact precautions varied by MDRO (Table 3). Compared to 2014, in 2022 facilities were less likely to use contact precautions indefinitely for MRSA (18% vs 6%) and VRE (31% vs 11%). Also, 180 facilities (90%) performed chlorhexidine bathing in at least some inpatients and 106 facilities (53%) used ultraviolet light or hydrogen peroxide vapor disinfection at discharge in some rooms. Furthermore, 89 facilities (44%) reported institutional changes to contact precautions policies after the start of the COVID-19 pandemic that remain in place. Conclusions: Use of contact precautions for patients with MDROs is heterogenous, and policies vary based on the organism. Although most hospitals still routinely use contact precautions for MRSA and VRE, this practice has declined substantially since 2014. Changes in contact-precaution policies may have been influenced by the COVID-19 pandemic, and more specifically, contemporary public health guidance is needed to define who requires contact precautions and for what duration.Disclosures: None

Handshake stewardship on adult acute-care surgical services

Background: Handshake stewardship is a variation of prospective audit and feedback that entails the individual review of patient charts by a physician–pharmacist collaborative team followed by in-person feedback to primary teams to communicate recommendations regarding optimal antibiotic use. Handshake stewardship has been shown to have durable effects in reducing antimicrobial use in children’s hospitals, but data regarding this intervention in adult hospitals are scarce. In particular, no data are available regarding the impact of this type of stewardship intervention on adult surgical units. We examined the effect of a handshake stewardship intervention at a large academic medical center on adult trauma and acute- and critical-care surgery (ACCS) units. Methods: The antimicrobial stewardship program (ASP) at Barnes-Jewish Hospital launched a handshake stewardship intervention targeting surgical floor teams in January 2022. These teams included the ACCS teams and a number of other surgical services. The intervention consisted of once weekly reviews and in-person rounds with the surgical floor teams along with the establishment of a 7 day per week “hotline” in which the surgical teams could contact an ID physician or pharmacist with questions regarding antibiotic use. Patients with formal ID consultations were not reviewed. Recommendations were tracked including the type, the antibiotic targeted, and recommendation acceptance or rejection. Descriptive statistics were performed to analyze these results. At the end of 12 months, antibiotic use in the floors covered by the ACCS teams were pulled from the NHSN AU module to perform an interrupted time-series analysis 12 months before and after the intervention. Results: Overall, 3,127 charts were reviewed during the intervention period and 637 recommendations were made to all the surgical teams. Opportunities for antibiotic use optimization were identified in ~20% of antibiotic orders. The overall recommendation acceptance rate was 71%. In the ACCS units, 272 interventions were recommended, with an acceptance rate of 67%. The most frequent recommendations were for antibiotic discontinuation (37%), antibiotic de-escalation (17%), shortening duration (12%), and broadening coverage (12%). Antibiotic usage trends (Fig. 1) on the ACCS floors, which were showing a nonsignificant increasing trend (P = .70) before and after the intervention, now show a nonsignificant decreasing trend (P = .20). Conclusions: There are numerous opportunities for antibiotic optimization on adult surgical floors. Although handshake stewardship is a labor-intensive intervention, preliminary findings after 1 year show that, on ACCS units, there may be a trend toward a sustained impact.Disclosures: None

A Needs Assessment for Infectious Diseases Consultation in Community Hospitals.

Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician. Patients aged 18years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians. 3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of Staphylococcus aureus bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807days of antimicrobial therapy. Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.

Editorial introductions.

Editorial introductions.

ЮБИЛЕЙ УЧИТЕЛЯ И ДРУГА (К 70-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ ВЛАДИМИРА МАКСИМОВИЧА ЦЫРКУНОВА)

The article describes the main stages of the professional path of a talented scientist and teacher, a well-known infectious disease physician, hepatologist and long-term head of the Department of Infectious Diseases of Grodno State Medical University, Honored Scientist of the Republic of Belarus, Doctor of Medical Sciences, Professor Vladimir Maksimovich Tsyrkunov.

Acute Syphilitic Posterior Placoid Chorioretinitis; a Case Report and Review

Background: Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is a rare but defining characteristic of ocular syphilis. Clinical findings are subtle, geographic, yellowish, macular lesions, affecting the outer-retina and inner choroid, and often associated with subretinal fluid in the early phase. This case report will review the clinical signs of ASPPC to aid the practitioner in identification and recognition of its clinical importance as it relates to early diagnosis, treatment, and prognosis. Case Report: A 79-year-old African American male presented to clinic with a chief complaint of blur in the right eye for the prior two days. Spectral Domain Optical Coherence Tomography (SD-OCT) of the macula revealed a shallow retinal pigment epithelial detachment with subretinal fluid centrally with some loss of the retinal pigment epithelium (RPE) and photoreceptors nasally in the right eye. There was rapid progression over a week to full loss of RPE and photoreceptors with reduction of vision to hand motion in the right eye, suggesting an infectious etiology. Serologic testing was ordered, and an RPR and FTA-ABS were both reactive. A diagnosis of acute syphilitic posterior placoid chorioretinopathy was made. An infectious disease physician treated the patient with IV penicillin G. There was a complete resolution of ocular findings. Conclusion: Syphilis should be considered for any ocular inflammatory condition. ASPPC is highly suggestive of syphilis. All patients with ocular syphilis should be evaluated for neurosyphilis. Treatment is IV penicillin G for 10-14 days and considered successful when there is a four-fold reduction in titers. Full visual recovery typically occurs within 12 weeks of treatment if a diagnosis and treatment are initiated early in the course of ocular disease.

Building an Infectious Disease Diversity, Equity, and Antiracism (ID2EA) Curriculum: A Single Center's Experience and Reflections.

In response to longstanding healthcare inequities unmasked by the Coronavirus Disease 2019 pandemic, the infectious diseases (ID) section at the Yale School of Medicine designed and implemented a pilot curriculum integrating Infectious Disease Diversity, Equity, and Antiracism (ID2EA) into ID educational training and measured program outcomes. We herein describe a mixed-methods assessment of section members on whether the ID2EA curriculum affected their beliefs and behaviors regarding racism and healthcare inequities. Participants rated the curriculum as useful (92% averaging across sessions) and effective in achieving stated learning objectives (89% averaging across sessions), including fostering understanding of how inequities and racism are linked to health disparities and identifying strategies to effectively deal with racism and inequities. Despite limitations in response rates and assessment of longer-term behavioral change, this work demonstrates that training in diversity, equity, and antiracism can be successfully integrated into ID physicians' educational activities and affect physicians' perspectives on these topics.

Snapshots of ID Week 2022

Snapshots of ID Week 2022

Validation of the Antifungal National Antimicrobial Prescribing Survey (AF-NAPS) quality assessment tool.

The Antifungal National Antimicrobial Prescribing Survey (AF-NAPS) was developed to undertake streamlined quality audits of antifungal prescribing. The validity and reliability of such tools is not characterized. To assess the validity and reliability of the AF-NAPS quality assessment tool. Case vignettes describing antifungal prescribing were prepared. A steering group was assembled to determine gold-standard classifications for appropriateness and guideline compliance. Infectious diseases physicians, antimicrobial stewardship (AMS) and specialist pharmacists undertook a survey to classify appropriateness and guideline compliance of prescriptions utilizing the AF-NAPS tool. Validity was measured as accuracy, sensitivity and specificity compared with gold standard. Inter-rater reliability was measured using Fleiss' kappa statistics. Assessors' responses and comments were thematically analysed to determine reasons for incorrect classification. Twenty-eight clinicians assessed 59 antifungal prescriptions. Overall accuracy of appropriateness assessment was 77.0% (sensitivity 85.3%, specificity 68.0%). Highest accuracy was seen amongst specialist (81%) and AMS pharmacists (79%). Prescriptions with lowest accuracy were in the haematology setting (69%), use of echinocandins (73%), mould-active azoles (75%) and for prophylaxis (71%). Inter-rater reliability was fair overall (0.3906), with moderate reliability amongst specialist pharmacists (0.5304). Barriers to accurate classification were incorrect use of the appropriateness matrix, knowledge gaps and lack of guidelines for some indications. The AF-NAPS is a valid tool, assisting assessors to correctly classify appropriate prescriptions more accurately than inappropriate prescriptions. Specialist and AMS pharmacists had similar performance, providing confidence that both can undertake AF-NAPS audits to a high standard. Identified reasons for incorrect classification will be targeted in the online tool and educational materials.

Time to embrace sepsis pathways and antibiotic prescribing decision support in the emergency department: Observations from a retrospective single site clinical audit.

To compare clinician documentation of sepsis for infective presentations in the ED against a formal sepsis pathway in the ED and to assess appropriateness of the initial parenteral antibiotic prescription for adult patients in ED. A retrospective, clinical audit of adult patients who received at least one parenteral antibiotic in ED over a 10-week period in 2018. Documented initial clinical impression was compared with an approved sepsis pathway. Antibiotic appropriateness was assessed using National Antimicrobial Prescribing Survey definitions. Assessment was carried out by an infectious diseases pharmacist, with input from an infectious diseases physician. Two hundred and nineteen infective presentations were included in the analysis. There was a discordance between the initial documented clinical impression compared with the classification when a sepsis pathway was applied. An initial documented clinical impression of sepsis and septic shock was present in 38 (60.3%) of the presentations compared to 63 presentations when a formal sepsis pathway was applied as a screening tool. There was a significant difference in the proportion of patients in each diagnostic group (infection, sepsis and septic shock) according to documented clinical impression versus sepsis pathway classification (P = 0.0002). There were 386 prescriptions for antibiotics as part of the initial management. Antibiotic appropriateness for the initial prescription was assessed as 63.7% appropriate, 27.2% inappropriate and 9.1% not assessable. Our observations demonstrate that use of a formal sepsis pathway may improve the screening and early diagnosis of sepsis and septic shock and that there is a need for antibiotic prescribing guidance in the ED.

Accuracy of identifying pediatric acute bacterial sinusitis diagnoses in outpatient claims data.

Acute bacterial sinusitis is among the most frequent outpatient infections in children and adolescents and is well suited to study in large healthcare utilization databases, but the validity of International Classification of Diseases, 10th Revision (ICD-10) codes together with antibiotic prescriptions to identify cases of acute bacterial sinusitis has not been established. We aimed to evaluate the validity of ICD-10 codes combined with antibiotic prescriptions to identify new diagnoses of acute bacterial sinusitis among pediatric patients evaluated in the outpatient setting. Children and adolescents aged 17 years and younger with an outpatient diagnosis of acute sinusitis along with an antibiotic prescription from an ambulatory facility affiliated with the Mass General Brigham health system were identified via a clinical data warehouse. Patients were stratified by age (0-5 years, 6-11 years, and 12-17 years), and 50 cases per age group were randomly sampled. Medical records were independently reviewed by two pediatric infectious diseases physicians to assess for the documentation of a clinician-defined diagnosis of acute bacterial sinusitis. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated. A total of 150 patients were included in the final cohort. Frontal, maxillary, and "unspecified" sinuses accounted for 88% of the diagnoses. The positive predictive value of the algorithm to identify clinician-defined diagnoses of acute bacterial sinusitis was 92% (95% CI 87%, 95%). The PPVs were consistent across age strata. ICD-10 codes for acute sinusitis, when paired with a same-day antibiotic prescription, have a high positive predictive value among a cohort of pediatric patients, suggesting that they can be used to study new acute bacterial sinusitis diagnoses with claims.

Duration of antibiotic treatment and timing of oral switching for bloodstream infections: a survey on the practices of infectious diseases and intensive care physicians

This study was designed to understand current practice in duration of antibiotic treatment and timing of intravenous (iv) to oral switch for common bacteraemic conditions amongst infectious diseases (ID) and intensive care unit (ICU) physicians. An online survey consisting of 18 questions comprising five common clinical bacteremia scenarios (adapted from the original survey designed by University of Toronto (Toronto, Ontario, Canada)) was conducted amongst Turkish ID and ICU physicians between November 2020 and November 2021. A total of 236 physicians (76.5 % ID and 17.5 % ICU) responded. The most commonly recommended duration for bacteremia was 14 days (42%), followed by 10 (27%) and 7 (18%) days. The median (IQR) recommended durations were 10 (10-14) days for central venous catheter associated bloodstream infection, 10 (7-14) days for bacteraemic pneumonia, 14 (10-14) days for bacteraemic urinary tract and intraabdominal infections, and 14 days (7-14) for bacteraemic skin and soft tissue infection. Carbapenem resistance but not pathogen type influenced the recommendations. There was not a significant difference in responses for most scenarios between ID and ICU physicians. A switch to oral antibiotics after a median duration of 7 (IQR 5-7) days of iv treatment was considered by 80% of respondents. Prolonged treatment was recommended for most clinical scenarios. Extended iv durations were recommended before oral switch. A presumption that resistant bacterial infections require longer therapy may be responsible for prolonged treatment durations.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

Echinocandin use in an Australian tertiary hospital: implications for antifungal stewardship

AbstractBackgroundInvasive candidiasis (IC) surveillance demonstrates an increasing incidence of resistance to azole‐based therapy. Consequently, echinocandins are often considered first‐line treatment for IC in critically ill patients. To better understand the complexities of decision‐making around echinocandin initiation, an evidence‐based audit tool was developed.AimTo describe echinocandin initiation and compliance with current guidelines.MethodA retrospective audit of echinocandin initiation was conducted between 1 January 2020 and 31 December 2020 at a quaternary referral hospital. An audit tool was developed by infectious diseases physicians and antimicrobial stewardship pharmacists, capturing patient demographics, microbiological results, indication for therapy, and risk factors for invasive fungal disease (IFD). Local guideline compliance was determined. This project was determined to be a quality improvement project and was not required to undergo ethical review according to the Alfred Hospital Ethics Committee procedures.ResultsOne hundred sixty‐seven patients were initiated on 214 courses of echinocandin therapy. Caspofungin was most commonly prescribed (n = 172, 80%). Of the 167 patients, most (n = 119, 71%) were in the intensive care unit at the time of initiation. Empiric therapy for sepsis or infection of unclear source was the most commonly documented indication (n = 117, 55%); 71% (n = 153) of all courses were deemed empiric therapy, followed by directed therapy (n = 55, 26%). The most common risk factors for IFD were recent exposure to broad‐spectrum antimicrobial therapy (n = 165, 99%) and the presence of a urinary catheter (n = 141, 84%). Most first doses were compliant with local guidelines (n = 144, 67%).ConclusionsEchinocandin therapy was commonly prescribed in critically ill patients with risk factors for IFD. Although the majority of prescriptions were empiric and compliant with local guidelines, improved guidelines incorporating additional patient factors should be included in future antifungal stewardship initiatives.

A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection.

Congenital cytomegalovirus (cCMV) continues to be a major public health care issue due to its high prevalence throughout the world. However, there is a paucity of studies evaluating how providers manage this infection. This study surveyed North American Pediatric Infectious Disease (PID) physicians to elicit their approach towards the evaluation and treatment of this condition. Thirty-two PID physicians responded to this survey. Institutional testing and screening for cCMV were infrequently reported. The respondents in general agreed upon most laboratory and diagnostic testing except for neuroimaging. For those tests, there was a disparity in indications for head ultrasound versus brain MRI imaging. Most (68.8%) agreed with the clinical practice of starting valganciclovir in an infant less than 1 month of age with one sign or symptom of disease, and 62.5% would do so for an infant with isolated sensorineural hearing loss. However, only 28.1% would treat cCMV-infected infants older than 1 month of age. In conclusion, few healthcare institutions represented by PID physicians in this cohort had a cCMV screening or testing initiative, yet most respondents would test at a much higher level based on their clinical practice. While there is general consensus in evaluation and treatment of these children, there are disparities in practices regarding neuroimaging and indications for antiviral treatment with respect to age and severity of disease. There is a great need for an evidence based policy statement to standardize cCMV workup and treatment.