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AbstractThe MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

AbstractIncreasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

OBJECTIVETo determine whether real-time availability of rapid molecular results of Staphylococcus aureuswould impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses.DESIGNWe performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge.SETTINGTwo urban, academic emergency departments.PATIENTSPatients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria.METHODSClinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed.RESULTSWe enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus–positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5% [95% CI, 1.1%–30.1%]) whereas methicillin-resistant S. aureus–positive patients receiving rapid test results were more often prescribed anti–methicillin-resistant S. aureusantibiotics (absolute difference, 21.5% [95% CI, 10.1%–33.0%]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes.CONCLUSIONAvailability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection.TRIAL REGISTRATIONclinicaltrials.govIdentifier: NCT01523899Infect. Control Hosp. Epidemiol.2015;36(12):1423–1430

(Abstracted from JAMA2016;315(17):1864–1873)Antibiotic-resistant infections, driven by inappropriate outpatient antibiotic use, are widespread in the United States. A number of initiatives, including the Centers for Disease Control and Prevention's (CDC's) Get Smart: Know When Antibiotics Work, the National Action Plan for Combating Antibiotic-Resistant Bacteria, and Healthcare Effectiveness Data and Information Set (HEDIS) have been undertaken to promote appropriate outpatient antibiotic use; however, the fraction that is inappropriate and has to be reduced is not known.

ABSTRACTThe Xpert Flu+RSV Xpress Assay is a fast, automated in vitrodiagnostic test for qualitative detection and differentiation of influenza A and B viruses and respiratory syncytial virus (RSV) performed on the Cepheid GeneXpert Xpress System. The objective of this study was to establish performance characteristics of the Xpert Flu+RSV Xpress Assay compared to those of the Prodesse ProFlu+ real-time reverse transcription-PCR (RT-PCR) assay (ProFlu+) for the detection of influenza A and B viruses as well as RSV in a Clinical Laboratory Improvement Amendments (CLIA)-waived (CW) setting. Overall, the assay, using fresh and frozen nasopharyngeal (NP) swabs, demonstrated high concordance with results of the ProFlu+ assay in the combined CW and non-CW settings with positive percent agreements (PPA) (100%, 100%, and 97.1%) and negative percent agreements (NPA) (95.2%, 99.5%, and 99.6%) for influenza A and B viruses and RSV, respectively. In conclusion, this multicenter study using the Cepheid Xpert Flu+RSV Xpress Assay demonstrated high sensitivities and specificities for influenza A and B viruses and RSV in ~60 min for use at the point-of-care in the CW setting.