Becker's Clinical Quality & Infection Control

18 ANTIBIOTIC RESISTANCE & STEWARDSHIP 3 barriers to nurse engagement in antibiotic stewardship By Anuja Vaidya A study published in the American Journal of Infec- tion Control examined nurses' confidence in engaging in antibiotic stewardship practices, as well as barriers to engagement. Researchers conducted an online survey of pediatric staff nurses employed at a children's hospital with a well-estab- lished prospective audit and feedback stewardship program. They used the survey to investigate 10 identified practices that fall within inpatient nurse responsibility and contribute to stewardship. They received responses from 180 nurses. The study showed nurses were very confident in assess- ing for adverse drug reaction histories, obtaining cultures prior to antibiotics and participating in patient education. However, they were not as confident in reviewing microbi- ology results to determine antibiotic appropriateness. Reported barriers to nurses engaging in stewardship included: • Not being included in rounds • Interdisciplinary power differentials • Nursing input not actively being sought n Vast majority of preterm babies receive early antibiotic therapy By Anuja Vaidya A majority of premature infants in the U.S. are given antibiotics, according to a study published in JAMA Network Open. Researchers conducted a retrospective cohort study using data from an administrative database of inpatient encounters from 297 academic and community hospitals nationwide. They studied 40,364 very low birth weight infants — including 12,947 extremely low birth weight infants who weighed less than 1,000 grams/2.20 pounds — admitted to the neonatal intensive care unit and who survived for at least one day. The study found 78.6 percent of very low birth weight infants and 87 percent of extremely low birth weight infants were given antibiotics within the first three days of life. There was a small but significant decrease in the rate of prolonged anti- biotic duration for very low birth weight infants over time, but not for extremely low birth weight infants. Additionally, researchers found early antibiotic exposures across centers varied. Around 61 percent of centers started antibiotic therapy for more than 75 percent of very low birth weight infants, and 84.8 percent started antibiotic therapy for more than 75 percent of extremely low birth weight infants. n 5 questions on antibiotic susceptibility testing with Accelerate Diagnostics By Leo Vartorella P reliminary data indicate the rate of sepsis mortality related to overall patient deaths is dropping at University Health Care System in Augusta, Ga. So what are they doing differently? Accelerate Diagnostics published a white paper with Becker's Hospital Review detailing the implementation of their Accelerate Pheno system at University Health Care System. Becker's caught up with Levi Kirwin, the Director of Commercial Marketing for Accelerate Diagnostics, to learn more about the use case. Editor's note: Responses were lightly edited for style and clarity. Question: What separates the Accelerate Phe- no™ system from other fast diagnostic tests? Levi Kirwin: It provides complete antibiotic susceptibilities direct from positive blood culture, reducing the time to help clinicians make sepsis interventions by an average of 40 hours per patient. Q: UHCS experienced a full day reduction of antibiotic therapy per patient encounter aer implementing the Accelerate Pheno™ system; how does this reduction affect patients and the hospital? LK: Reducing days of antibiotic therapy has been shown to improve outcomes. It correlates with reduction in incidence of Clostridium difficile infection, acute kidney injury and ototoxicity; this also reduces costs related to antibiotic therapy and bed days. Q: What sorts of teams does a provider need to have in place to ensure effective imple- mentation of the Accelerate Pheno™ system? LK: An antimicrobial stewardship team should include strong sponsorship from C-suite and/or quality leadership, an infectious diseases physician, infectious diseases-trained pharmacist(s), and include stakeholders from critical care, infection prevention and the laboratory. Q: How does the Accelerate Pheno™ system interact with an EMR such as Epic? LK: Results are electronically transmitted directly into the EHR, with the capability to alert intensivists and hospitalists to critical results, such as the recommended antibiotic treatment for multidrug resistant organisms involved in sepsis. Q: What kind of training do clinicians require to implement this system? LK: Antibiotic stewardship teams, in concert with clinical decision support from the vendor, will frequently lead trainings with intensivists/hospital- ists on grand rounds, or in-ser vice, to prepare clinicians to inter vene using fast susceptibility results without delay. n

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