26
ANTIBIOTIC
RESISTANCE
&
STEWARDSHIP
3 best metrics
for assessing
antimicrobial
stewardship
practices
By Mackenzie Bean
H
ealth experts identified new
best practices that could help
hospitals improve antimicro-
bial stewardship programs, according
to an article published in e Joint
Commission Journal on Quality and
Patient Safety.
e article summarizes findings
from an expert panel that discussed
best practices for antimicrobial
stewardship interventions and
measurement during a 2018 meeting
hosted by e Joint Commission and
e Pew Charitable Trusts.
e panel identified two interventions
as best practices not detailed in current
antimicrobial stewardship guidelines
and recommended best practices:
• Diagnostic stewardship —
Addressing diagnostic errors that
lead to inappropriate antibiotic
prescriptions
• Handshake stewardship —
Engaging frontline clinicians
on a regular basis to learn about
their perceived barriers to
antimicrobial stewardship
e panel also identified three pre-
ferred metrics for measuring antimi-
crobial stewardship efforts:
• Days of therapy
• Clostridioides difficile rates
• Adherence to facility-specific
guidelines n
Prolonged antibiotic exposure common
after patient discharge, study finds
By Anuja Vaidya
N
early 40 percent of antibiotic exposure occurs after a patient has been
discharged from the hospital, according to a study published in Infection
Control & Hospital Epidemiology.
Researchers conducted a retrospective cohort study at two community hospitals
and one academic medical center. They collected electronic data on inpatient
and discharge antibiotic prescriptions from April to September 2016. They gath-
ered information on inpatient antibiotic use from electronic medication adminis-
tration records, and they calculated antibiotic use after discharge using electronic
discharge prescriptions.
Of 45,693 inpatient admissions, 23,447 (51 percent) received antibiotics during
their stay, and 7,442 (16 percent) were given electronic discharge prescriptions.
Researchers found patients continued antibiotic therapy for a median of eight
days after their discharge. Prescriptions peaked at five, seven, 10 and 14 days.
Antibiotic exposure after discharge accounted for 38 percent of a patient's total
number of antibiotic exposure days. n
Genome sequencing could help hospitals
track superbug transmission, researchers say
By Mackenzie Bean
W
hole genome sequencing may be an effective method to track the
spread of antibiotic-resistant bacteria in hospitals, according to re-
search presented June 23 at the American Society for Microbiology's
annual meeting in San Francisco.
For the study, state and local health officials used whole genome sequencing to
examine the transmission of a Klebsiella pneumoniae bacteria strain at a hospital
in Northern California. The strain demonstrated resistance to carbapenems — a
last-resort antibiotic.
The hospital found eight patients tested positive for this strain between 2013
and 2015.
"[Whole genome sequencing] allowed us to understand and demonstrate
connections among the patients over a multiple year time period, which
would not have been possible using epidemiologic information alone," study
author Varvara Kozyreva, PhD, of the California Department of Public Health,
said in a news release.
Dr. Kozyreva said whole genome sequencing could help hospitals and health offi-
cials identify disease transmission paths and implement interventions sooner. n
