Stewardship / Resistance Scan for September 12, 2022

Study sheds light on excess antibiotics in discharged hospital patients

A study conducted at Johns Hopkins Hospital found that three-quarters of the patients studied were prescribed excess antibiotics at discharge, and the duration was often longer than recommended, researchers reported last week in the American Journal of Infection Control.

For the study, researchers reviewed data from adult patients discharged from Johns Hopkins Hospital on oral antibiotics in July-August 2020 and assessed antibiotic indication, antibiotic appropriateness, and duration of treatment. Survival was defined as days of prescribed therapy in excess of institution-recommended or national guidelines.

During the study period, 196 patients were discharged on antibiotics, with 147 (75%) overprescribed antibiotic days. Antibiotic choice was appropriate in 70.4% of cases, but duration of discharge was only appropriate in 32.1% of cases based on antibiotic indication, and total duration of therapy was identified as appropriate in only 24.5% of cases. Compared to all patients, those receiving antibiotic excess at discharge had a lower rate of adequate therapy based on antibiotic indication. Excessive antibiotic duration was particularly likely with unknown diagnosis (23%), skin and soft tissue infections (16%) and antibiotic prophylaxis (12%).

The study authors say improved adherence to recommended antibiotic prescribing practices before and at hospital discharge and during the completion of therapy is an “important but underappreciated” goal for antibiotic stewardship.

“Increased efforts towards antimicrobial responsibility both in the outpatient setting and on discharge from the hospital or emergency department can improve antibiotic prescribing by physicians and ensure that antibiotics are only prescribed when necessary,” they wrote.
September 10 Bin J Infect Control abstract

Study shows MRSA bacteremia rate is much higher in NYC COVID-19 patients

The rate of methicillin resistance Staphylococcus aureus (MRSA) bacteremia was five times higher in COVID-19 patients than in non-COVID patients at 11 New York City hospitals during the pandemic, researchers reported in last week Infection control and hospital epidemiology.

From January 2019 to March 2022, there were 216 cases of MRSA bacteremia in healthcare facilities (HCFO) at the 11 public acute care centers of New York City Health and Hospitals Enterprise, a healthcare system serving primarily low-income patients in the Bronx, Brooklyn, Manhattan and Queens. The baseline rate of MRSA bacteremia was 0.073 per 1,000 patient days in 2019 and increased to 0.53, 0.20, 0.51 and 0.43 infections per 1,000 patient days during four COVID-19 flare-ups. From January 2020 to March 2022, the overall rate of MRSA bacteremia in patients without COVID-19 was 0.065 per 1,000 patient days and 0.34 per 1,000 patient days in patients diagnosed with COVID-19.

Compared to patients without COVID-19, MRSA bacteremia patients with COVID-19 were older (67.2 vs. 55.6 years), more likely to be Asian (31% vs. 4%), less likely to be black (13% vs. 36% ), and are more likely to be in an ICU at the time of MRSA bacteremia (58% vs. 34%). In addition, 77% of patients with COVID-19 were on mechanical ventilation, 63% were on corticosteroids, and 79% met the National Healthcare Safety Network’s definition of pneumonia. Mortality rates were higher in patients with COVID-19 (81% vs. 34%) and only 4% of patients with HCFO-MRSA bacteremia and COVID-19 were discharged home compared to 23% of patients without COVID-19.

The study authors say that prolonged hospitalization and the high rates of corticosteroids and mechanical ventilation likely contributed to superimposed MRSA infection, as did increased use of the antibiotic ceftriaxone during the initial surge of COVID-19. They also suggest that the number of cases of central line-associated MRSA bacteremia may be underestimated.

“The elevated rates of HCFO-MRSA bacteremia during the pandemic once again underscore the important role of antibiotic stewardship and infection control efforts, particularly during the surge in patients with COVID-19,” they wrote.
September 9th Infect Control Hosp Epidemic abstract