Becker's Hospital Review

30 ANTIBIOTIC RESISTANCE & STEWARDSHIP Antibiotic resistance more prevalent in device-related infections, study finds By Gabrielle Masson H ealthcare-associated infections are more likely to be antibiotic-resistant when related to medical devices than surgical procedures, according to a report from the CDC's National Healthcare Safety Network published Nov. 25 in Infection Control & Hospital Epidemiology. Researchers analyzed 2015-17 CDC and NHSN data from central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator- associated events and surgical site infections in adult patients at 5,626 facilities, most of which were general acute care hospitals. e three most commonly reported bacteria were E. coli (18 percent), Staphylococcus aureus (12 percent) and Klebsiella spp (9 percent). Pathogens varied by location and infection type, but antibiotic resistance for most bacteria was significantly higher among device-associated HAIs than among SSIs. For example, Enterococcus faecium in VRE infections was resistant to antibiotics in 55.6 percent of SSIs, while antibiotic resistance rates were 26.5 percent higher for device-related infections, at 82.1 percent. Long-term acute care hospitals had significantly higher rates of antibiotic resistance than general hospital wards. A related study of pediatric HAIs presented similar findings. n Antibiotic prescriptions fall when physicians see peer prescribing rates By Anuja Vaidya A n intervention that includes comparing physicians' antibiotic prescribing patterns may help cut antibiotic prescriptions by more than one-third, according to a study published in Antimicrobial Agents and Chemotherapy. Researchers examined antibiotic prescribing patterns of primary care physicians at seven Veterans Affairs clinics. They implemented an intervention that included offering 73 primary care physicians an education session, followed by monthly emails with their antibiotic prescribing rate, the prescribing rates of their peers and a target rate. Fifty phy- sicians participated in the education sessions and received the emails. Researchers compared prescribing rates from January 2017 to July 2017, after the intervention was put into place, to a period before the intervention, January 2016 to June 2016. They found that the average monthly antibiotic prescrip- tions declined from 76.9 per 1,000 office visits in the 2016 period to 49.5 per 1,000 office visits in the 2017 period, a 35.6 percent reduction. They also found that unnecessary antibiotic prescribing declined from 58.8 percent in 2016 to 38.9 percent in 2017, and appropriate antibiotic prescribing increased by 50.8 percent from the period before the intervention was imple- mented compared to the period after. n HHS agency releases toolkit to improve antibiotic stewardship By Anuja Vaidya A n HHS agency has released a toolkit to guide hospitals and health systems trying to curb inappropriate antibiotic use. The Agency for Healthcare Research and Quality created the Acute Care Hospital Toolkit, which focuses on three areas: • Antibiotic stewardship program improvement • Establishing a safety culture around antibiotic prescribing • Sharing best practices for the diagnosis and treatment of common infections The toolkit aims to help hospitals enhance antibiotic prescribing by using the "Four Moments of Antibiotic Decision Making" framework that encourages clini- cians to ask themselves four questions when deciding antibiotic therapy for patients, beginning with "Does my patient have an infection that requires antibiotics?" The toolkit offers an explanation of the framework as well as presentations and tools to support implemen- tation of the framework. n

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