Search

Acinetobacter infections have increased and gained attention because of the organism's prolonged environmental survival and propensity to develop antimicrobial drug resistance. The effect of multidrug-resistant (MDR) Acinetobacter infection on clinical outcomes has not been reported. A retrospective, matched cohort investigation was performed at 2 Baltimore hospitals to examine outcomes of patients with MDR Acinetobacter infection compared with patients with susceptible Acinetobacter infections and patients without Acinetobacter infections. Multivariable analysis controlling for severity of illness and underlying disease identified an independent association between patients with MDR Acinetobacter infection (n = 96) and increased hospital and intensive care unit length of stay compared with 91 patients with susceptible Acinetobacter infection (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.2-5.2 and OR 2.1, 95% CI 1.0-4.3] respectively) and 89 uninfected patients (OR 2.5, 95% CI 1.2-5.4 and OR 4.2, 95% CI 1.5-11.6] respectively). Increased hospitalization associated with MDR Acinetobacter infection emphasizes the need for infection control strategies to prevent cross-transmission in healthcare settings. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to online resources for information on antimicrobial resistance in a previous issue.

Objective: We conducted a quality improvement initiative to restrict fluoroquinolone prescribing on two inpatient units housing high-risk patients and applied a human factors approach to understanding the barriers and facilitators to success of this intervention by front-line providers. Methods: This was a mixed-methods, quasi-experimental study. This study was conducted on two inpatient units at a tertiary care academic medical center: the medical-surgical intensive care and abdominal solid organ transplant units. Unit-level data were collected retrospectively for 24 months pre- and post- fluoroquinolone restriction intervention, implemented in July 2016, for all admissions to the study units. Our restriction intervention required antimicrobial stewardship pre-approval for fluoroquinolone prescribing. We explored barriers and facilitators to optimal fluoroquinolone prescribing using semi-structured interviews attending, fellow and resident physicians, advanced practice providers and pharmacists on these units. Results: Hospital-onset C. difficile infection did not decrease significantly, but fluoroquinolone use declined significantly from 111.6 to 19.8 days of therapy per 1000 patient-days without negatively impacting length of stay, readmissions or mortality. Third generation cephalosporin and aminoglycoside use increased post-restriction. Providers identified our institution's strong antimicrobial stewardship program and pharmacy involvement in antimicrobial decision making as key facilitators of fluoroquinolone optimization and patient complexity, lack of provider education and organizational culture as barriers to optimal prescribing. Conclusions: Fluoroquinolones can be safely restricted even among high-risk patients without negatively impacting length of stay, readmissions or mortality. Our study provides a framework for successful antimicrobial stewardship interventions informed by perceptions of front line providers. [ABSTRACT FROM AUTHOR]

Background. Control of methicillin-resistant Staphylococcus aureus (MRSA) is difficult in select populations. We used molecular typing to study the effect of universal surveillance and decolonization of carriers, without isolation, on MRSA transmission in a specialized unit.Methods. Patients admitted to the unit were screened for nasal MRSA at admission and discharge. Those who acquired MRSA during their stay were identified and linked to carriers with shared time in unit. Molecular typing of isolates was performed to identify transmission.Results. Of 3285 admissions, 82% were tested for MRSA nasal carriage; the discharge screening compliance was 64.7%. Admission prevalence was 2.3% among patients screened, and 7 (0.42%) acquired nasal MRSA during their stay. All patients who acquired MRSA shared time in the unit with a colonized patient. There were 3.9 MRSA acquisitions per 1000 at-risk days. Isolates from 5 patients that acquired MRSA during their stay as well as their potential donors (11 donor: recipient patient pairs) were available for typing. Pulsed-field gel electrophoresis matched 1 acquisition isolate to a colonized patient isolate. There were no MRSA infections during the study period.Conclusions. Despite less than perfect nasal screening compliance and exemption from traditional isolation precautions, acquisition of MRSA was 0.42% in this patient population over a course of 4.75 years, including a single case of acquisition, genetically similar to a known potential donor source. Screening for MRSA colonization and decolonizing of carriers was sufficient in reducing transmission in this vulnerable population. [ABSTRACT FROM PUBLISHER]

We assessed the prevalence, risk factors, and clinical outcomes of patients co-colonized with vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) upon admission to the medical and surgical intensive care units (ICUs) of a tertiary-care facility between January 1, 2002, and December 31, 2003. Co-colonization was defined as a VRE-positive perirectal surveillance culture with an MRSA-positive anterior nares surveillance culture collected concurrently. Among 2,440 patients, 65 (2.7%) were co-colonized. Independent risk factors included age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), admission to the medical ICU (OR 4.38, 95% CI 2.46-7.81), male sex (OR 1.93, 95% CI 1.14-3.30), and receiving antimicrobial drugs on a previous admission within 1 year (OR 3.06, 95% CI 1.85-5.07). None of the co-colonized patients would have been identified with clinical cultures alone. We report a high prevalence of VRE/MRSA co-colonization upon admission to ICUs at a tertiary-care hospital. [ABSTRACT FROM AUTHOR]

Background Antimicrobial stewardship programs (ASPs) can reduce the incidence of hospital-onset Clostridioides difficile infection (HO-CDI) by limiting unnecessary exposure to high-risk antibiotics, including fluoroquinolones (FQ). However, restriction policies are challenging to implement and sustain. In a mixed methods study, we explored the barriers, facilitators and efficacy of an FQ restriction policy to reduce HO-CDIs among high-risk patients. Methods Our ASP instituted a pilot FQ restriction policy in our ICU and solid-organ transplant wards. We evaluated 24 months of pre- and post-intervention data, including: FQ and alternative agent use, length of stay (LOS), readmission rate, mortality and HO-CDI. We conducted 12 semi-structured interviews with front-line providers, applying the Systems Engineering Initiative for Patient Safety framework to examine perceptions of FQ use, prescribing indications, perceived relationships between FQ use and HO-CDI, and barriers imposed by FQ restrictions. Time-series analysis was performed to evaluate FQ and HO-CDI data. Results FQ use decreased from an average of 111.6 days of therapy (DOT) per 1,000 patient-days pre-intervention to 19.8 DOT/1,000 patient-days (P < 0.0001). Average readmission rate, LOS on pilot units, total antibiotic use, and use of cefepime decreased after FQ restriction. Conversely, use of ceftriaxone, aminoglycosides and piperacillin–tazobactam all increased. The average HO-CDI rate was significantly lower post-intervention, although time series analysis showed a post-intervention increase in the trend in infection rate compared with the pre-intervention trend. Qualitative analysis of interviews revealed β-lactam allergy and pending discharge were barriers to FQ restriction; a patient's history of CDI and pharmacist involvement in antimicrobial decision-making facilitated FQ restriction. Conclusion An FQ restriction policy significantly decreased FQ use without adversely affecting readmission rate, LOS or mortality. Knowledge of barriers and facilitators to FQ use optimization among front-line staff can inform future successful ASP interventions. Further investigation into the effect of FQ restriction on HO-CDI is needed. Disclosures Alexander Lepak, MD, Paratek Pharmaceuticals: Research Grant; Tetraphase Pharmaceuticals: Research Grant. [ABSTRACT FROM AUTHOR]