C andida auris is an emerging, multidrug-resistant, healthcare-associated fungal pathogen that was first reported in Japan in 2009 and has now been isolated on 6 continents (1-9). C. auris has been identified as the causative pathogen in various invasive fungal infections, including bloodstream infections (2,4), and is associated with outbreaks across healthcare settings (6,10). Risk factors for C. auris infection are similar to other Candida infections including prolonged hospitalization, abdominal surgery, diabetes mellitus, intensive care unit (ICU) admission, use of central venous and urinary catheters, immunocompromising conditions, chronic kidney disease, and exposure to broad-spectrum antibiotic and antifungal agents (10-13). Investigations in the Chicago, Illinois, USA, area have found a high prevalence of C. auris colonization at ventilator-capable skilled nursing facilities (14) and have shown higher rates of C. auris colonization among patients who are mechanically ventilated, have a gastrostomy tube, or have a urinary catheter (15). Reported mortality rates attributable to invasive C. auris infection range from 30% to 59% globally (13,16) and from 22% to 57% in the United States (8,10,17). C. auris isolates are often resistant to fluconazole and have variable susceptibility to other antifungal agents (13,16). The Centers for Disease Control and Prevention (CDC) currently recommends echinocandins as empiric therapy for suspected or confirmed C. auris infections (18). However, recent reports have indicated reduced susceptibilities to echinocandins and suggest that resistance might be inducible under antifungal pressure (8,16). Previous reports of C. auris infections and outbreaks have largely focused on epidemiologic information, and data on treatment strategies and clinical outcomes are limited (6,8,10,16-21). We report microbiologic data for C. auris isolates from a multisite health system in Illinois and an assessment of clinical outcomes for patients treated for C. auris infections. Methods This study is a retrospective cohort analysis of patients at 8 hospitals within a single health system located in the Chicago metropolitan area. We included all patients >18 years old who had >1 positive culture for C. auris from any anatomic site during January 1,
BackgroundAntimicrobial stewardship (AMS) programs emerged in response to rising rates of resistance and adverse effects associated with inappropriate antimicrobial utilization. Optimal metrics and strategies (e.g., preauthorization, prospective audit and feedback) for AMS remain to be elucidated. This study evaluated the impact of a multidisciplinary, rounding-based AMS strategy (i.e., Handshake Stewardship) on antimicrobial utilization and prescribing practices at a pediatric hospital.MethodsThis was a single-center, retrospective quality improvement study at a community, teaching children’s hospital. All pediatric and neonatal inpatients with active antimicrobial orders between July 2018 and March 2019 were included in the study, and endpoints were compared with data from July 2017- March 2018. Antimicrobial courses were prospectively audited by a multidisciplinary AMS team, and feedback was provided to the primary teams during Handshake Stewardship rounds. The primary endpoint was a number of interventions made and the corresponding acceptance rates. The secondary endpoint was days of therapy (DOT) per 1000 patient-days. Descriptive statistics were performed on all continuous and categorical data as appropriate.ResultsOf 2238 antimicrobial courses reviewed, 710 (32%) required intervention, and 86% of the interventions made were accepted. The top 3 indications evaluated were respiratory (n = 522, 23%), sepsis/bacteremia (n = 351, 16%), and surgical prophylaxis (n = 266, 12%). Of the respiratory courses reviewed, there were 228 opportunities for antimicrobial optimization. The most common interventions were: bug-drug optimization (n = 208, 29%), discontinuation of anti-infective (n = 136, 19%), and dose optimization (n = 120, 17%). No significant difference was observed for overall, ceftriaxone, meropenem, and vancomycin DOT pre- and post-implementation of Handshake Stewardship. However, a statistically significant reduction in DOTs was observed for piperacillin–tazobactam (15.2 vs. 7.4, P = 0.004) and a nonsignificant reduction in meropenem (9.5 vs. 6.2).ConclusionRounding-based, Handshake AMS was associated with overall high intervention acceptance rates and a reduction in commonly utilized broad-spectrum antimicrobials.Disclosures All authors: No reported disclosures.
BackgroundThe Clinical and Laboratory Standards Institute (CLSI) lowered the minimum inhibitory concentration (MIC) breakpoints of various β-lactam antimicrobials eliminating the need for confirmatory testing of extended-spectrum β-lactamase (ESBL) organisms. Our institution adopted the new CLSI breakpoints in June 2015. This multi-site study assessed the impact of laboratory cessation of ESBL reporting on the MIC distribution of commonly used antimicrobials and clinical outcomes.MethodsThis retrospective study included adult inpatients with positive blood cultures for Escherichia coli, Klebsiella pneumoniae, K. oxytoca, or Proteus mirabilis from June 2012 to June 2018. Patients were included in the pre-implementation group if they had an ESBL-positive blood culture from June 2012 to May 2015 and in the post-implementation group if they had a ceftriaxone-resistant organism from June 2015 to June 2018. Patients who died or transitioned to hospice within 48 hours of blood culture identification or before final susceptibilities were excluded. The primary outcome was MIC distribution of ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, fluoroquinolones, and carbapenems. Secondary outcomes were antimicrobial prescribing patterns, 30-day all-cause mortality, 30-day re-infection rate, and time to microbiological clearance.ResultsA total of 249 patients were included (n = 40, pre-implementation; n = 209, post-implementation). Pitt Bacteremia Scores were significantly higher in the pre-implementation group (3.59 ± 2.85 vs. 2.21 ± 2.06; P = 0.0004). The median MIC distribution for each antimicrobial stayed within one dilution throughout the study timeframe. Carbapenem use decreased in the post-implementation group [n = 35 (87%) vs. n = 131 (63%)]. No significant differences were noted for other secondary outcomes: 30-day all-cause mortality (15% vs. 10%; P = 0.40), 30-day re-infection rate (2.5% vs. 4.3%; P = 1), and time to microbiological clearance (2.28 ± 1.2 vs. 2.41 ± 1.76 days; P = 0.72).ConclusionAdoption of lowered CLSI breakpoints did not impact MIC distribution of select antimicrobials for Enterobacteriaceae; however, it has affected antimicrobial prescribing patterns.Disclosures All authors: No reported disclosures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.