Assessment of the Appropriateness of Antimicrobial Use in US Hospitals

Magill, Shelley S.; O’Leary, Erin; Ray, Susan M.; Kainer, Marion; Evans, Christopher; Bamberg, Wendy; Johnston, Helen; Janelle, Sarah J.; Oyewumi, Tolulope; Lynfield, Ruth; Rainbow, Jean; Warnke, Linn; Nadle, Joelle; Thompson, Deborah; Sharmin, Shamima; Pierce, Rebecca; Zhang, Alexia Y.; Ocampo, Valerie; Maloney, Meghan; Greissman, Samantha; Wilson, Lucy; Dumyati, Ghinwa; Edwards, Jonathan R.; Chea, Nora; Neuhauser, Melinda M.

doi:10.1001/jamanetworkopen.2021.2007

Cited by 70 publications

(64 citation statements)

References 32 publications

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“…We and others have found that most patients with SARS-CoV-2 are treated with antibiotics, although bacterial infections are fairly rare [ 2–9 ]. Overuse of antibiotics is not unique to the pandemic: An analysis of 2015 data found that the use of antibiotics in patients without a positive urine or blood culture was common [ 30 ]. Nevertheless, this trend has been exacerbated by the influx of patients with SARS-CoV-2 infections, who are more likely to receive antibiotics than SARS-CoV-2-negative or -untested patients [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-Positive and -Negative US Patients With a Positive Bacterial Culture: A Multicenter Evaluation From March to November 2020

Puzniak

Bauer

Moise

et al. 2021

Open Forum Infectious Diseases

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Background Increased utilization of antimicrobial therapy has been observed during the coronavirus disease 2019 pandemic. We evaluated hospital outcomes based on the adequacy of antibacterial therapy for bacterial pathogens in US patients. Methods This multicenter retrospective study included patients with ≥24 hours of inpatient admission, ≥24 hours of antibiotic therapy, and discharge/death from March-November 2020 at 201 US hospitals in the BD Insights Research Database. Included patients had a test for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and a positive bacterial culture (gram-positive or gram-negative). We used generalized linear mixed models to evaluate the impact of inadequate empiric therapy (IET), defined as therapy not active against the identified bacteria or no antimicrobial therapy in the 48 hours following culture, on in-hospital mortality and hospital and intensive care unit (ICU) length of stay (LOS). Results Of 438,888 SARS-CoV-2 tested patients, 39,203 (8.9%) had positive bacterial cultures. Among patients with positive cultures, 9.4% were SARS-CoV-2 positive, 74.4% had a gram-negative pathogen, 25.6% had a gram-positive pathogen, and 44.1% received IET for the bacterial infection. The odds of mortality were 21% higher for IET (odds ratio 1.21 [95% confidence interval (CI), 1.10–1.33]; P<.001) compared with adequate empiric therapy. IET was also associated with increased hospital LOS(16.1 [95% CI, 15.5–16.7] vs 14.5 [95% CI 13.9–15.1] days; (P<.001). Both mortality and hospital LOS findings remained consistent for SARS-CoV-2-positive and -negative patients. Conclusions Bacterial pathogens continue to play an important role in hospital outcomes during the pandemic. Adequate and timely therapeutic management may help ensure better outcomes.

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Section: Discussionmentioning

confidence: 99%

Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-Positive and -Negative US Patients With a Positive Bacterial Culture: A Multicenter Evaluation From March to November 2020

Puzniak

Bauer

Moise

et al. 2021

Open Forum Infectious Diseases

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“… 10 The increase in infections caused by MDR (resistant to one or more agents in at least three different classes of agents) bacteria poses significant problems for individuals with serious and potentially life-threatening infections given the few available and effective therapeutic options. 1 , 2 , 4 …”

Section: Introductionmentioning

confidence: 99%

In vitro activity of a novel aminomethylcycline antibacterial (KBP-7072), a third-generation tetracycline, against clinical isolates with molecularly characterized tetracycline resistance mechanisms

Pfaller

Liu

et al. 2021

JAC-Antimicrobial Resistance

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Objectives This study evaluated the in vitro activity of KBP-7072 against 413 contemporary surveillance isolates, including subsets with known tetracycline resistance genes. Materials In total, 105 Klebsiella pneumoniae (51 tetracycline resistant), 103 Escherichia coli (52 tetracycline resistant), 103 Staphylococcus aureus (51 tetracycline resistant) and 102 Streptococcus pneumoniae (51 tetracycline resistant) isolates were included. These isolates were tested by broth microdilution using fresh media. CLSI/EUCAST breakpoints were applied, except for tigecycline and omadacycline, which used FDA criteria. Results KBP-7072 (MIC50, 0.06 mg/L), tigecycline (MIC50, 0.12 and 0.25 mg/L) and omadacycline (MIC50, 0.12 and 0.5 mg/L) showed similar MIC50s for tetracycline-susceptible and -resistant S. aureus. Other tetracycline comparators had their MIC50 increased 64- to 256-fold by tet. For S. pneumoniae, KBP-7072 (MIC50/90, ≤0.015/0.03 mg/L) showed the lowest MICs, which remained unchanged for tetracycline-susceptible or -resistant isolates [mostly tet(M)]. Similar MICs were observed for omadacycline (MIC50/90, 0.03–0.06/0.06 mg/L) and tigecycline (MIC50/90, 0.03/0.03 mg/L) in the S. pneumoniae population. Tetracycline-susceptible and -resistant E. coli [94.2% tet(A)/tet(B)], KBP-7072 (MIC90, 0.25 and 1 mg/L, respectively) and tigecycline (MIC90, 0.25 and 0.5 mg/L) showed similar MIC90s. KBP-7072 (MIC50/90, 0.25/0.5 mg/L) and tigecycline (MIC50/90, 0.5/0.5 mg/L) had the lowest MIC for tetracycline-susceptible K. pneumoniae. The MIC for KBP-7072 (MIC50/90, 1/4 mg/L) and tigecycline (MIC50/90, 1/2 mg/L) increased 2- to 8-fold for tetracycline-resistant K. pneumoniae, which mostly produced Tet(A). Conclusions KBP-7072 activity was minimally affected by the presence of acquired tetracycline genes.

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“…Nevertheless, clinicians routinely prescribe antibiotics in ways that diverge from this evidence, such as prescribing them when not indicated, for durations longer than necessary, or selecting broad-spectrum antibiotics when a narrower-spectrum agent would suffice. 1,2 This overuse of antibiotics contributes to the public health crisis of antibiotic resistance while exposing patients to potential antibiotic-related harms.…”

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confidence: 99%

Leveraging implementation science to advance antibiotic stewardship practice and research

Livorsi

Drainoni

Reisinger

et al. 2021

Infect. Control Hosp. Epidemiol.

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Assessment of the Appropriateness of Antimicrobial Use in US Hospitals

Abstract: This cross-sectional study evaluates the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia or a urinary tract infection present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment.

Cited by 70 publications

References 32 publications

Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-Positive and -Negative US Patients With a Positive Bacterial Culture: A Multicenter Evaluation From March to November 2020

Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-Positive and -Negative US Patients With a Positive Bacterial Culture: A Multicenter Evaluation From March to November 2020

In vitro activity of a novel aminomethylcycline antibacterial (KBP-7072), a third-generation tetracycline, against clinical isolates with molecularly characterized tetracycline resistance mechanisms

Leveraging implementation science to advance antibiotic stewardship practice and research

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