How can the EHR improve Antimicrobial Stewardship? 🏥💊
Our study of 136 prescriptions found only 37% included an indication and 75% a duration.
ASPs should consider:
✅ Required indication/duration
✅ Reason for urine cultures
✅ Order sets with pre-filled info
Read: doi.org/10.1017/ash....
@brxad.bsky.social et al: Is AMR a topic confined to our small echo chamber? Here are 4 strategies to help engage the other 99.9% in the conversation about AMR (happy #WAAW week!) doi.org/10.1017/ash....
A screen shot of the antibiotic personality quiz
It’s World AMR Awareness Week, and this year I had the honor to re-imagine and doodle the antibiotics in the antibiotic personality quiz 😇🖍️
Thank u @brxad.bsky.social for this amazing and fun opportunity!
C’mon, take the quiz, it’s a #WAAW tradition 😉💊
#IDSky
quiz.tryinteract.com#/59e68e3a8ec...
Solving #AMR requires all of us. Here are 4 ways to break the echo chamber and reach the other 99.9%:
🧠 Better knowledge translation
👨👩👦 Public engagement
🌏 One Health partnerships
👩⚖️ Science–policy collaboration
Read more: doi.org/10.1017/ash....
#AMRAwareCA @ashejournal.bsky.social
Cross-sectional study of hospital antibiograms identifies areas for improvement that could help support clinical decision making & AMR monitoring:
doi.org/10.1093/jaca...
@brxad.bsky.social #JACAMRNews
Figure 2
An antibiotic audit-and-feedback intervention for family physicians targeting patients aged 65 and older was associated with a 7% reduction in antibiotic prescriptions for patients of all ages. https://ja.ma/3ImcG2W
New in JAC AMR - our review of antibiograms from 60 hospitals found ++ variability in design
Many opportunities for improvement, for ex include:
- detail about the population
- guidance on how to interpret
-info on how duplicate patients are handled
doi.org/10.1093/jaca...
#idsky
🆕 Evaluating BSI in Ontario we found #AMR was associated with a 10% ⬆️ risk of death equivalent to 1.2 deaths/100,000 people/year
These estimates are lower than those in previous literature, which may be due to robust adjustment for confounding
doi.org/10.1093/cid/...
@cidjournal.bsky.social
From @brxad.bsky.social et al, a reminder global ID collaborations do and should continue to exist and strengthen in the current political landscape. doi.org/10.1017/ash....
📈 New Public Health Ontario epidemiology report:
C. auris cases in Ontario are infrequent (22 cases, 2017–2024) but are gradually rising.
🧪 94% fluconazole resistant
🧪 35% amphotericin B resistant
🧪 0% echinocandin resistant
📊 Read more: bit.ly/4cIAwBg
#AntimicrobialStewardship
🐶🐱 Companion animals need #AntimicrobialStewardship too! In our new SR/MA (led by Dr. Fiona Emdin), we examined short vs. long antibiotic durations for UTIs in dogs & cats.📉 Pooled RR for cure = 0.55 (95% CI: 0.23–1.27), very low certainty.
🔓 doi.org/10.1186/s129...
More high-quality data needed!
Survey of US adults <65 yo comparing abx non-users to frequent users (>3x/year) in @jama.com Open
Frequent abx users more likely to distrust science, want abx for viral URIs, need health literacy support, be medical maximizers, and had more comorbidities
#IDSky
jamanetwork.com/journals/jam...
Visual abstract illustrating teaching hospitals, larger hospitals, and those with designated funding and/or resourcing for their antibiotic stewardship program were more likely to participate in antibiotic use tracking and reporting
🆕 in @ashejournal.bsky.social Another example of "you get what you pay for" - hospitals with designated funding/resources to support their antibiotic stewardship program had a 3.7X higher odds of participating in AMU reporting and benchmarking
doi.org/10.1017/ash.... #IDSky
UTI vs "UTI" ⁉️
In this cohort of patients diagnosed with "UTI" only about 30% had symptoms consistent with infection. ED setting and patients with mental status changes are key opportunities for antibiotic stewardship.
onlinelibrary.wiley.com/doi/10.1002/...
Shorter is greener! 🍃♻️
Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT
Fantastic point! #IDSky #AMSsky
Local public health organizations have an important role to play in mitigating #AMR
They should be leveraged for knowledge translation/mobilization, optimizing surveillance & establishing strategic collaborations
https://doi.org/10.1093/jacamr/dlae187
@brxad.bsky.social @dianeashiru.bsky.social
CDC's Morbidity and Mortality Weekly Report (MMWR) has provided real-time data and analysis about disease outbreaks and emerging health threats without a break every week since 1960.
Until today.
Enthused that our article on BCx stewardship during the BCx shortage made the best of OFID 2024!
academic.oup.com/ofid/article...
In order to mitigate #antimicrobialresistance, we need more stewards! This scoping review shows that local public health is a key player in knowledge dissemination, data collection & design and implementation of stewardship strategies:
doi.org/10.1093/jaca...
Audit & feedback with peer comparison works to improve antibiotic prescribing in primary care. Now, health system leaders and policy-makers must take decisive steps to integrate this strategy into the healthcare system.
qualitysafety.bmj.com/content/earl...
👏 @kevinschwartz.bsky.social
We found lower rates of bacterial infection in patients with SARS-CoV-2 compared to Flu and RSV. This is driven by lower rates of co-infection (<48h) in patients with COVID. NB: testing practices may also vary across infections and over time.
doi.org/10.1093/ofid...
@ofidjournal.bsky.social #IDSky
Special thanks to Kevin Schwartz @kevinschwartz.bsky.social for his leadership and Kevin Brown, PhD for his expertise and teaching me about instrumental variable analysis!
This highlights the importance of the analytical method to reduce risk of bias when measuring abx benefits and harms in observational studies. This also supports the fact that there is no additional harm to using shorter courses and are still consistent with #shorterisbetter.
In the instrumental variable analysis we found no difference in HARMS or SAFETY outcomes across three antibiotics - cephalexin, ciprofloxacin, and amoxicillin. But interestingly when using a propensity matched analysis we did find an increase in SAFETY outcomes with long duration
Then we evaluated 117,682 community dwelling patients of those prescribers and looked at their HARMS outcomes (abx overuse) - such as AMR, side effects, C. diff, and SAFETY /balancing outcomes (abx underuse) - such as repeat Rx, hospital visits and mortality
There is a lot of of inter-prescriber variability in antibiotic duration prescribing, even after accounting for patient factors. Duration prescribing is pseudo-random! So we classified MD prescribers based on their proportion of long-duration antibiotic prescriptions - the "instrumental variable"
🆕in @cidjournal.bsky.social
- our instrumental variable analysis of community-dwelling adults 66+ found that longer antibiotic courses were NOT associated with an increased benefit or harm compared to shorter courses. doi.org/10.1093/cid/...
🧵thread below #IDSky
Antibiotic stewardship programs need dedicated funding to be effective. Hospital ASPs with funding & resources use less fluoroquinolones, anti-pseudomonal agents, and clindamycin.
🆕 in @ashejournal.bsky.social
📰 doi.org/10.1017/ash....
#IDSky
Just a little nudge (stewards love nudges!) that if you get an abstract accepted at SHEA Spring, we subsequently publish the supplement with them all in it 🤩#IDSky