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138. Focused Outpatient Antibiograms: Time for Widespread Implementation?

BACKGROUND: Significant antimicrobial use occurs in outpatient settings, making this an important area for expanding stewardship. Data show over 260 million annual prescriptions in the U.S. Family practitioners prescribed the most antibiotic courses (24%)(1). Urinary Tract Infections (UTI) comprise...

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Autores principales: Manandhar, Sabina, Cook, Paul P, Schwartz, Michael D, Duncan, Heather M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776824/
http://dx.doi.org/10.1093/ofid/ofaa439.183
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author Manandhar, Sabina
Cook, Paul P
Schwartz, Michael D
Duncan, Heather M
author_facet Manandhar, Sabina
Cook, Paul P
Schwartz, Michael D
Duncan, Heather M
author_sort Manandhar, Sabina
collection PubMed
description BACKGROUND: Significant antimicrobial use occurs in outpatient settings, making this an important area for expanding stewardship. Data show over 260 million annual prescriptions in the U.S. Family practitioners prescribed the most antibiotic courses (24%)(1). Urinary Tract Infections (UTI) comprise one of the most common indications for antibiotics. In this study, antibiogram data were compiled for urinary isolates of E coli collected from all outpatients as well as Family Medicine-specific (FM) clinics in an academic medical center in Eastern NC. The objective is to identify susceptibility variations for E. coli from urine isolates specific to combined outpatient and academic FM clinics compared to composite non-intensive care unit (ICU) data. Also, assess impact of providers’ knowledge/access to a focused antibiogram on choice of empiric therapy. METHODS: Data were electronically obtained from the microbiology laboratory at Vidant Health (VH), a large regional system serving over 1.4 million people from 29 counties in Eastern NC. All urine cultures with E. coli from 9/2018 - 9/2019 were included. Two focused antibiograms were then developed via MedMind. A pre and post intervention survey was conducted with FM practitioners, including residents. Intervention was defined as a brief talk to educate providers about variations identified via focused antibiograms. Survey results were compared to assess for intent to change practice. RESULTS: Pre-survey data are noted in Figure 1. Post-survey changes are described in Figure 2 noting that 100% of respondents now felt a need to have access to focused antibiogram data. There were 1107 E coli urinary isolates for all outpatients and 104 for FM clinics only. Figure 3 highlights key differences in antibiogram data, especially enhanced susceptibilities for common antibiotics in FM-specific clinics when compared to composite institutional data. Pre-Intervention Survey [Image: see text] Post-Intervention Survey [Image: see text] Comparison of Antibiogram [Image: see text] CONCLUSION: Composite hospital antibiograms may not be optimal for determining empiric UTI treatment in the community and antibiotic selections thought to be suboptimal in an institution may be effective in outpatient settings. Thus, antibiograms developed specifically for outpatient clinics, especially in academic centers, have potential to greatly enhance appropriate care. DISCLOSURES: Paul P. Cook, MD, Contrafect (Grant/Research Support, Scientific Research Study Investigator)Gilead (Grant/Research Support, Scientific Research Study Investigator)Leonard-Meron (Grant/Research Support, Scientific Research Study Investigator)Lilly (Grant/Research Support, Scientific Research Study Investigator)
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spelling pubmed-77768242021-01-07 138. Focused Outpatient Antibiograms: Time for Widespread Implementation? Manandhar, Sabina Cook, Paul P Schwartz, Michael D Duncan, Heather M Open Forum Infect Dis Poster Abstracts BACKGROUND: Significant antimicrobial use occurs in outpatient settings, making this an important area for expanding stewardship. Data show over 260 million annual prescriptions in the U.S. Family practitioners prescribed the most antibiotic courses (24%)(1). Urinary Tract Infections (UTI) comprise one of the most common indications for antibiotics. In this study, antibiogram data were compiled for urinary isolates of E coli collected from all outpatients as well as Family Medicine-specific (FM) clinics in an academic medical center in Eastern NC. The objective is to identify susceptibility variations for E. coli from urine isolates specific to combined outpatient and academic FM clinics compared to composite non-intensive care unit (ICU) data. Also, assess impact of providers’ knowledge/access to a focused antibiogram on choice of empiric therapy. METHODS: Data were electronically obtained from the microbiology laboratory at Vidant Health (VH), a large regional system serving over 1.4 million people from 29 counties in Eastern NC. All urine cultures with E. coli from 9/2018 - 9/2019 were included. Two focused antibiograms were then developed via MedMind. A pre and post intervention survey was conducted with FM practitioners, including residents. Intervention was defined as a brief talk to educate providers about variations identified via focused antibiograms. Survey results were compared to assess for intent to change practice. RESULTS: Pre-survey data are noted in Figure 1. Post-survey changes are described in Figure 2 noting that 100% of respondents now felt a need to have access to focused antibiogram data. There were 1107 E coli urinary isolates for all outpatients and 104 for FM clinics only. Figure 3 highlights key differences in antibiogram data, especially enhanced susceptibilities for common antibiotics in FM-specific clinics when compared to composite institutional data. Pre-Intervention Survey [Image: see text] Post-Intervention Survey [Image: see text] Comparison of Antibiogram [Image: see text] CONCLUSION: Composite hospital antibiograms may not be optimal for determining empiric UTI treatment in the community and antibiotic selections thought to be suboptimal in an institution may be effective in outpatient settings. Thus, antibiograms developed specifically for outpatient clinics, especially in academic centers, have potential to greatly enhance appropriate care. DISCLOSURES: Paul P. Cook, MD, Contrafect (Grant/Research Support, Scientific Research Study Investigator)Gilead (Grant/Research Support, Scientific Research Study Investigator)Leonard-Meron (Grant/Research Support, Scientific Research Study Investigator)Lilly (Grant/Research Support, Scientific Research Study Investigator) Oxford University Press 2020-12-31 /pmc/articles/PMC7776824/ http://dx.doi.org/10.1093/ofid/ofaa439.183 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Manandhar, Sabina
Cook, Paul P
Schwartz, Michael D
Duncan, Heather M
138. Focused Outpatient Antibiograms: Time for Widespread Implementation?
title 138. Focused Outpatient Antibiograms: Time for Widespread Implementation?
title_full 138. Focused Outpatient Antibiograms: Time for Widespread Implementation?
title_fullStr 138. Focused Outpatient Antibiograms: Time for Widespread Implementation?
title_full_unstemmed 138. Focused Outpatient Antibiograms: Time for Widespread Implementation?
title_short 138. Focused Outpatient Antibiograms: Time for Widespread Implementation?
title_sort 138. focused outpatient antibiograms: time for widespread implementation?
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776824/
http://dx.doi.org/10.1093/ofid/ofaa439.183
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