Becker's Clinical Quality & Infection Control

15 ANTIBIOTIC RESISTANCE & STEWARDSHIP Viewpoint: 4 moments to change how antibiotics are prescribed By Megan Knowles F our moments in the antibiotic de- cision-making process can make all the difference in curbing antibiotic resistance, three physicians wrote in a JAMA commentary. e Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use aims to improve antibiotic prescribing practices by training clinicians to incorporate these four moments when prescribing antibiotics: 1. Does this patient have an infection that requires antibiotics? Providers oen pre- scribe antibiotics to hospitalized patients in response to an abnormal vital sign, but they should stop and consider whether the patient has an infection that needs an antibiotic or a viral infection that will not benefit from antibiotic treatment. 2. Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate? Lack of appropri- ate cultures can lead to prolonged antibiotic therapy, the authors said. Providers must ensure timely administration of appropriate empirical antibiotic therapy. "[is moment] reminds the prescriber to think carefully about specific patient risk factors and sever- ity of illness in association with the likely source of infection," the authors said. 3. A day or more has passed. Can I stop antibiotics? Can I narrow therapy? Can I change from intravenous to oral therapy? "Too oen, the decision to continue anti- biotic therapy is not revisited as more clinical and microbiological data become available," the authors said. Prescribers should perform a daily antibiotic timeout for every patient receiving antibiotics, which may include the clinical team having a discussion or completing a written form during daily patient rounds. 4. What duration of antibiotic therapy is needed for this patient's diagnosis? A growing number of studies support shorter durations of antibiotic therapy than previ- ously administered for infections, the au- thors said. "e duration of therapy should be based on the literature and an assessment of whether patients have had appropriate clinical responses." n 84% of patients receive antibiotics for infection-like symptoms, survey finds By Mackenzie Bean M ost patients who seek treatment for infection-like symp- toms receive a prescription for antibiotics, according to the January 2019 IBM Watson Health-NPR Health Poll. To conduct the poll, IBM surveyed 3,006 Americans on their ex- periences with antibiotic prescriptions between Sept. 1-15, 2018. Four survey findings to know: 1. Ninety percent of respondents said that they or someone in their household had visited a medical professional in the last year. Physician's offices were the most common setting for these visits (73 percent), followed by urgent care facilities (9 percent), emergency rooms (8 percent), retail health clinics (5 percent) and other care settings (4 percent). 2. Of the individuals who visited a healthcare professional in the past year, 24 percent sought treatment for infection-like symp- toms such as fever, sore throat or congestion. 3. Eighty-nine percent of individuals with these symptoms said the clinician discussed the appropriateness of prescribing anti- biotics, and 84 percent said they were prescribed an antibiotic. 4. Ninety-eight percent of respondents who received an antibi- otic prescription had it filled, and 96 percent took the full course as prescribed. n Wyoming hospital patient diagnosed with rare, drug-resistant infection By Mackenzie Bean T he Wyoming Department of Health on Jan. 9 confirmed a patient at Cheyenne Regional Medical Center was diagnosed with a rare, drug-resistant infection. Testing revealed the bacteria responsible for the infection is in the Enterobacteriaceae family and contains an antibiotic-resistant gene called MCR-1. The gene has only been discovered in "a handful of states over the past few years," Alexia Harrist, MD, PhD, a state health officer and state epidemiologist with WDH, said in a press release. It does not appear the patient contracted the in- fection at the hospital, the health department said. "Although this finding is unexpected and some- thing we are taking seriously, we believe the con- tact precautions already in place at the hospital have likely limited the potential spread of the bacteria," Dr. Harrist said in the press release. The patient responded to treatment and was in good condition as of Jan. 9. n

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