Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2021/08/stewardship-resistance-scan-aug-03-2021
Stewardship / Resistance Scan for Aug 03, 2021
Antibiotic use in terminal cancer; Antimicrobial stewardship and COVID-19
Filed Under:
Antimicrobial Stewardship
Study examines ways to cut antibiotics in terminal cancer patients
A single-center study of terminal cancer patients found a high rate of antibiotic use within the last 30 days of life, with significantly lower use among those who asked for limited antimicrobial treatment, researchers reported yesterday in Open Forum Infectious Diseases.
Despite uncertain benefits and the risk of adverse events and antimicrobial resistance, antimicrobial use in patients with terminal cancer is frequently continued after transition to comfort care and discontinued less than 1 day prior to death. To determine whether completing a Physician Orders for Life Sustaining Treatment (POLST) form and an accompanying antimicrobial preferences document had any relationship with antimicrobial use at the end of life, researchers from the University of Washington and the Fred Hutchinson Cancer Research Center conducted a retrospective study of patients who died at the Seattle Cancer Care Alliance from Jan 1, 2016, through Jun 30, 2019.
Among the 1,295 patients identified for the study, 1,070 (83%) received one or more inpatient antibiotic within the last 30 days of life. The median total and intravenous (IV) antibiotic use was 1,077 and 677 days of therapy per 1,000 inpatient days, respectively. A total of 318 (24.6%) patients had a completed POLST form on file, and 120 (37.7%) of those were completed at least 30 days before death; 35/120 (29.2%) specified limited antimicrobial use, 55/120 (45.8%) specified full antimicrobial use, and 30/120 (25.8%) omitted antimicrobial preference.
Compared with those without a POLST, patients specifying limited antibiotic use at least 30 days before death had significantly lower total antimicrobial days of therapy (DOT; adjusted incidence rate ratio [IRR], 0.68; 95% confidence interval [CI], 0.49 to 0.95) and IV antibiotic DOT (IRR, 0.57; 95% CI, 0.38 to 0.86).
The study authors note that Washington is only 1 of 18 states that includes a separate section on antibiotics in their POLST forms.
"This supports our hypothesis that completion of the antimicrobial preferences section of the POLST form at an intermediate interval prior to death is associated with subsequent antimicrobial exposure in the 30 days prior to death," they wrote. They said states should include antimicrobial prescribing data on their POLST forms.
Aug 2 Open Forum Infect Dis abstract
Stewardship steps tied to less antibiotic use in COVID-19 patients
A retrospective study of patients in Kentucky suggests antibiotic stewardship interventions may safely cut antibiotic use in COVID-19 patients, researchers reported yesterday in Infection Control and Hospital Epidemiology.
Among 173 patients who received antibiotics for COVID-19 from June through July 2020 at a community healthcare system in Louisville, 91 (52.6%) met criteria for early discontinuation of antibiotics, and 82 patients (47.7%) were in the late-discontinuation group. The decision to discontinue antibiotics in COVID-19 patients without bacterial co-infection was made by trained clinical pharmacists who were part of the hospital's antimicrobial stewardship (AMS) team. Among the outcomes evaluated by the study were the percentage of AMS recommendations accepted, length of antibiotic therapy, length of hospital stay, and mortality.
In early-antibiotic-discontinuation patients, 41.8% had an AMS intervention, with an 86.8% acceptance rate, while 29.3% of patients in the late-antibiotic-discontinuation group had an AMS intervention, with a 54.2% acceptance rate. The median antibiotic length of therapy was 3 days in the early-discontinuation group and 7 days in the late-discontinuation group.
The overall in-hospital mortality rate was 17.3%; inpatient mortality occurred in 14.3% of the early-discontinuation group and 20.7% in the late-discontinuation group. Median length of stay was similar in the two groups, at 7 and 9 days, respectively.
The study authors say the findings may add to prescriber confidence when discontinuing antibiotics in COVID-19 patients, and demonstrate that stewardship interventions may lead to shorter lengths of antibiotic therapy.
"AMS recommendations could be a key factor in promoting appropriate antibiotic use in COVID-19 patients," they wrote.
Aug 2 Infect Control Hosp Epidemiol abstract
Stewardship / Resistance Scan for Aug 03, 2021
Antibiotic use in terminal cancer; Antimicrobial stewardship and COVID-19
Filed Under:
Antimicrobial Stewardship
Study examines ways to cut antibiotics in terminal cancer patients
A single-center study of terminal cancer patients found a high rate of antibiotic use within the last 30 days of life, with significantly lower use among those who asked for limited antimicrobial treatment, researchers reported yesterday in Open Forum Infectious Diseases.
Despite uncertain benefits and the risk of adverse events and antimicrobial resistance, antimicrobial use in patients with terminal cancer is frequently continued after transition to comfort care and discontinued less than 1 day prior to death. To determine whether completing a Physician Orders for Life Sustaining Treatment (POLST) form and an accompanying antimicrobial preferences document had any relationship with antimicrobial use at the end of life, researchers from the University of Washington and the Fred Hutchinson Cancer Research Center conducted a retrospective study of patients who died at the Seattle Cancer Care Alliance from Jan 1, 2016, through Jun 30, 2019.
Among the 1,295 patients identified for the study, 1,070 (83%) received one or more inpatient antibiotic within the last 30 days of life. The median total and intravenous (IV) antibiotic use was 1,077 and 677 days of therapy per 1,000 inpatient days, respectively. A total of 318 (24.6%) patients had a completed POLST form on file, and 120 (37.7%) of those were completed at least 30 days before death; 35/120 (29.2%) specified limited antimicrobial use, 55/120 (45.8%) specified full antimicrobial use, and 30/120 (25.8%) omitted antimicrobial preference.
Compared with those without a POLST, patients specifying limited antibiotic use at least 30 days before death had significantly lower total antimicrobial days of therapy (DOT; adjusted incidence rate ratio [IRR], 0.68; 95% confidence interval [CI], 0.49 to 0.95) and IV antibiotic DOT (IRR, 0.57; 95% CI, 0.38 to 0.86).
The study authors note that Washington is only 1 of 18 states that includes a separate section on antibiotics in their POLST forms.
"This supports our hypothesis that completion of the antimicrobial preferences section of the POLST form at an intermediate interval prior to death is associated with subsequent antimicrobial exposure in the 30 days prior to death," they wrote. They said states should include antimicrobial prescribing data on their POLST forms.
Aug 2 Open Forum Infect Dis abstract
Stewardship steps tied to less antibiotic use in COVID-19 patients
A retrospective study of patients in Kentucky suggests antibiotic stewardship interventions may safely cut antibiotic use in COVID-19 patients, researchers reported yesterday in Infection Control and Hospital Epidemiology.
Among 173 patients who received antibiotics for COVID-19 from June through July 2020 at a community healthcare system in Louisville, 91 (52.6%) met criteria for early discontinuation of antibiotics, and 82 patients (47.7%) were in the late-discontinuation group. The decision to discontinue antibiotics in COVID-19 patients without bacterial co-infection was made by trained clinical pharmacists who were part of the hospital's antimicrobial stewardship (AMS) team. Among the outcomes evaluated by the study were the percentage of AMS recommendations accepted, length of antibiotic therapy, length of hospital stay, and mortality.
In early-antibiotic-discontinuation patients, 41.8% had an AMS intervention, with an 86.8% acceptance rate, while 29.3% of patients in the late-antibiotic-discontinuation group had an AMS intervention, with a 54.2% acceptance rate. The median antibiotic length of therapy was 3 days in the early-discontinuation group and 7 days in the late-discontinuation group.
The overall in-hospital mortality rate was 17.3%; inpatient mortality occurred in 14.3% of the early-discontinuation group and 20.7% in the late-discontinuation group. Median length of stay was similar in the two groups, at 7 and 9 days, respectively.
The study authors say the findings may add to prescriber confidence when discontinuing antibiotics in COVID-19 patients, and demonstrate that stewardship interventions may lead to shorter lengths of antibiotic therapy.
"AMS recommendations could be a key factor in promoting appropriate antibiotic use in COVID-19 patients," they wrote.
Aug 2 Infect Control Hosp Epidemiol abstract