bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient antibiotic use for common infectious diagnoses: Patterns in telehealth during the emergence of COVID-19
Authors: Mongilardi Nicole , Wilson Brigid , Bej Taissa , Song Sunah , Jump Federico , Perez Federico , Akpoji Ukwen 
Published: May 2022

Background: The Veterans’ Affairs (VA) healthcare system has had established telehealth programs for several years. Even so, the COVID-19 pandemic led to an expansion of and changes in these services. Little is known about the influence of the increased use of telehealth due to the COVID-19 pandemic on antibiotic prescriptions in outpatient settings. Here, we report on changes in visit modality and antibiotic prescribing at primary care clinics at a large VA medical center after the emergence of the COVID-19 pandemic. Methods: Using VA administrative databases, we identified primary care visits from March 2018 to November 2019 (before the COVID-19 pandemic) and March 2020 to November 2021 (during the COVID-19 pandemic), which permitted us to account for seasonality while analyzing visit modality and antibiotic trends. For primary care visits during the pre–COVID-19 and COVID-19 periods, we have described the type of visit (in-person or telehealth), diagnostic codes for any infection, and antibiotic prescriptions. Results: The patient population was primarily men (89%) with a mean age of 62.9 years (SD, ±15.3) at first visit. The most common medical conditions were diabetes mellitus (26%) and chronic lung disease (17%). Comparing visits during the pre–COVID-19 and the COVID-19 periods, the proportions of telehealth visits were 20% (17,708 of 88,565) and 74% (69,891 of 94,937), respectively (Fig. 1). The proportions of visits with an antibiotic prescription were 1.4% (1,212 of 88,565) and 0.8% (798 of 94,396), respectively. When considered by the type of visit, the rates of antibiotics prescribed were consistent during the pre–COVID-19 and COVID-19 periods, with a lower rate for telehealth visits (Fig. 2). In both periods, >50% of antibiotic prescriptions occurred during visits without an associated infectious disease diagnosis. Conclusions: Compared to the pre–COVID-19 period, primary care providers at a large VA medical center prescribed fewer antibiotics during the COVID-19 period, and they saw most of their patients via telehealth. These results suggest that some aspects of telehealth may support clinical practices consistent with antibiotic stewardship. The prescription of an antibiotic without an associated diagnostic code also suggests opportunities to improve implementation of antibiotic stewardship principles in primary care settings.Funding: This work was supported by the Merck Investigator Studies Program (grant no. MISP 59266 to F.P. and R.J.) and by funds and facilities provided by the Cleveland Geriatric Research.Disclosures: None
Do hospitalists who prescribe high (risk-adjusted) rates of antibiotics do so repeatedly?
Authors: Onwubiko Udodirim , Mehta Christina , Wiley Zanthia , Jacob Jesse , Jones Ashley , Hassan Shabir , Sexton Marybeth , Suchindran Sujit , Fridkin Scott 
Published: May 2022

Background: Provider-specific prescribing metrics can be used for benchmarking and feedback to reduce unnecessary antibiotic use; however, metrics must be credible. To improve credibility of a recently described risk-adjusted antibiotic prescribing metric for hospital medicine service (HMS) providers, we assessed whether providers who initially prescribed excess antibiotics continued to prescribe antibiotics excessively. Methods: We linked administration and billing data among patients at 4 acute-care hospitals (1,571 beds) to calculate days of therapy (DOT) ordered by individual hospitalists for each of 3 NHSN antibiotic groupings: broad-spectrum hospital onset (BS-HO), broad-spectrum community-onset (BS-CO), or anti-MRSA for each patient day billed from January 2020 to June 2021. To incorporate repeated measures by provider, mixed models adjusted for patient-mix characteristics (eg, % encounters with urinary tract infection, etc) were used to calculate serial, bimonthly, provider-specific, observed-to-expected ratios (OERs). An OER of 1.25 indicates that the prescribing rate observed was 25% higher than predicted, adjusting for patient mix. We then used log binomial generalized estimating equations to assess whether a high prescribing rate (defined as an OER ≥ 1.25) for an individual provider in an earlier bimonthly period was associated with a persistent high rate for that provider in the following period. Results: Overall, 975 bimonthly periods were evaluated from 136 hospitalists. Most (58%) contributed data the entire 18-month study period. Median OERs were similar between hospitals: 0.94 (IQR, 0.65–1.28) for BS-HO antibiotic use, 0.99 (IQR, 0.73–1.24) for BS-CO antibiotic use, and 0.95 (IQR, 0.65–1.28) for anti-MRSA antibiotic use. At the individual prescriber level, roughly one-quarter of bimonthly OERs (range varied by group and hospital from 21% to 31%) were categorized as high. At 3 of the 4 hospitals, a provider with a high OER for either BS-HO or BS-CO antibiotic use in any bimonthly period was more likely to have a high OER in the subsequent period (Fig. 1). These observed risk ratios were statistically significant for BS-HO antibiotic use at only 2 hospitals: hospital A risk ratio (RR) was 1.54 (95% CI, 1.10–2.16); hospital B RR was 1.28 (95% CI, 0.90–1.82); hospital C RR was 0.76 (95% CI, 0.39–1.48); and ospital D RR was 1.71 (95% CI, 1.09–2.68). Conclusions: Our findings suggest that hospitalists with a higher than expected 2-month period of antibiotic prescribing are likely to continue to have elevated prescribing rates in the following period, particularly for BS-HO antibiotics. These findings increase the credibility of using a 2-month prescribing metric for BS-HO antibiotic stewardship efforts; further work is needed to evaluate utility for other antibiotic groupings.Funding: NoneDisclosures: None
The effect of a parenteral-to-oral conversion program for high-bioavailability antibiotics use
Authors: Jang Wooyoung , Kim Bongyoung 
Published: May 2022

Background: Appropriate conversion of antibiotics from parenteral to the oral route can lower the risk of catheter-associated infections, reduce medical costs, and shorten hospitalization. We investigated the effect of a parenteral-to-oral conversion program on high-bioavailability antibiotics conducted by medical students and the changes in perceptions of oral antibiotics after participating in the program. Methods: The parenteral-to-oral conversion program was implemented as a core clinical practice course for the fifth-year medical students in 2021 at the infectious diseases department in an affiliated hospital of a medical school in Korea. Half of the students in this class participated in the program from January to October 2021. An evaluation of the possibility of oral conversion was performed for parenterally administered, high oral-bioavailability antibiotics including ciprofloxacin, levofloxacin, moxifloxacin, metronidazole, linezolid, and trimethoprim–sulfamethoxazole. These agents are prescribed in the departments of pulmonology, gastroenterology, general surgery, and neurology. The medical students reviewed medical records for the patients treated with those antibiotics and wrote a recommendation for oral conversion for the cases with “possible oral conversion” after an infectious disease specialist confirmed their assessments. The cases without administration of any oral drugs or with the duration of parenteral antibiotic use of <3 days were excluded from the evaluation. The following cases were considered as “impossible oral conversion” and were excluded from the intervention: (1) admitted to the ICUs, (2) admitted to the protected isolation rooms, (3) difficult to take oral medication, (4) risk of insufficient medication absorption, e) bone and joint infections, (5) fever within 24 hours, (6) insufficient response to antibiotic therapy, and (7) recommended to use intravenous antibiotics by consultation with an infectious disease specialist. Furthermore, a survey was conducted on the perception of oral antibiotics in medical students before and after clinical practice to evaluate the educational effect of this program. Results: In total, 923 cases were reviewed, and 190 (20.6%) of 923 antibiotics prescriptions with high oral bioavailability were found to be administered parenterally even though they could be converted oral administration. Among these 190 antibiotics prescriptions, 46 (24.2%) were changed via a written proposal within 48 hours, 83 (43.7%) proposed changes were declined, and 61 (32.1%) antibiotics prescriptions were discontinued within 48 hours. Through this program, students have gained a better perception of oral antibiotics. Conclusions: This parenteral-to-oral conversion program showed a 24.2% acceptance rate of oral antibiotics conversions in the hospital, and it had significant educational effects on medical students regarding an appropriate perception of oral antibiotics.Funding: NoneDisclosures: None
Procalcitonin as marker for bacterial coinfection among adult COVID-19 patients in a tertiary-care hospital in the Philippines
Authors: Pesebre Angelie Lorraine , Abad Cybele Lara , Francisco Jan Jorge , Ong Justin Allister 
Published: May 2022

Background: Antimicrobials are often given to patients with COVID-19 despite the absence of a bacterial coinfection. Procalcitonin (PCT), when elevated, often indicates the presence of a bacterial infection and is used to guide empiric antibiotic therapy. We sought to determine the utility of PCT and the optimal cutoff value of PCT among patients with COVID-19. Methods: We retrospectively reviewed all COVID-19 confirmed ca-ses hospitalized in our institution from March to December 2020. Of 729 cases, we included 403 (55.3%) who had baseline PCT and blood or respiratory tract specimens (eg, sputum, endotracheal aspirate) within 48 hours of admission. Participants were classified according to PCT levels and COVID-19 severity. A receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) obtained was used to compute the possible optimal cutoff value using the Youden index. A χ2 test was used to define association between groups according to the characteristics of variables. Results: Of a total cohort of 403, 245 (57%) were male, with an overall median age of 60 years (range, 22–94). Overall, 28 presented with mild COVID-19, 194 presented with moderate COVID-19, and 181 presented with severe or critical COVID-19. Moreover, 363 (90%) were given antibiotics. Of 28 with mild COVID-19, 22 (79%) received empiric antibiotics. The rate of bacterial coinfection was high at 28% (113 of 403). Klebsiella pneumoniae was the most commonly identified microorganism: 52 (19.5%) of 266 patients. Based on the ROC curve, the optimal cutoff for PCT was 4.72 ng/mL, with 97% specificity and only 6% sensitivity. Only 17 participants had PCT > 4.72 ng/mL. Of these, 1 was mild, 5 were moderate COVID-19, 8 had severe COVID-19, and 3 had critical COVID-19; all received antibiotic therapy. Conclusions: In our cohort, the rate of bacterial coinfection was high. A PCT of >4.72 ng/mL increased the likelihood of a coinfection. However, PCT had poor sensitivity and may not detect the presence of bacterial coinfection, especially when used alone. Serial PCT monitoring, its use in conjunction with other markers, or as a prognostic tool, need to be explored further.Funding: NoneDisclosures: None
The Strike Team as an implementation strategy for surgical infection prevention
Authors: Hatharaliyadda Buddhi , Schmitz Michelle , Osman Fauzia , Van Dyke Kenneth , Safdar Nasia , Pop-Vicas Aurora , Heise Charles , Mork Anne 
Published: May 2022

Background: Surgical site infections (SSIs) incur up to $10 billion annually due to their excessive morbidity. SSI prevention bundles have had variable success in colorectal surgery. For example, at the University of Wisconsin Hospital, a 505-bed regional referral center, SSI rates have remained high despite the introduction of a 14-element SSI prevention bundle in 2016. To aid in the implementation of this complex bundle, the hospital started Strike Teams in 2019. We have described the impact of Strike Teams on colorectal SSI rates in our tertiary-care hospital. Methods: A Strike Team with key stakeholders from colorectal surgery (ie, surgeon, OR director, nurses, surgical technicians), anesthesia, pharmacy, infection prevention, and infectious disease was formed, supported by the hospital’s executive leadership. The Strike Team met monthly throughout 2019 to review each SSI case, discussed barriers to adherence for the SSI prevention bundle elements with implementation difficulties (Table 1), and proposed actionable feedback to increase adherence. The latter was disseminated to frontline clinicians by the teams’ surgical leaders during everyday clinical practice. The Strike Team was paused in 2020 due to resource reallocation in response to the COVID-19 pandemic. Monthly and quarterly SSI surveillance was conducted according to CDC guidance. Results: Colorectal SSI rates before, after, and during Strike Team activity are shown in Fig. 1. Adherence rates to the bundle elements targeted by the Strike Team are shown in Fig. 2. Conclusions: Adherence to the preferred antibiotic prophylaxis increased, although adherence to other bundle elements of focus did not change significantly. SSI rates decreased below our expectation while the Strike Team was active in our hospital, although SSI reduction was not sustained. Further research should study the effectiveness of Strike Teams as a long-term implementation strategy for SSI prevention in colorectal surgery.Funding: NoneDisclosures: None
A qualitative study of parent and childcare leadership perspectives on attendance policies at childcare centers
Authors: Poole Nicole , Dorsey-Holliman Brooke , Anderson Leisha , O’Leary Sean , Glaros Chloe 
Published: May 2022

Background: Attendance policies for common pediatric illnesses vary widely across childcare centers despite nationally published guidelines from the American Academy of Pediatrics. The COVID-19 pandemic has exacerbated this problem, leading to economic loss from parental work absenteeism and excess medicalization of children with common illnesses. We sought to understand barriers to and recommendations for adopting best practices on attendance policies at Early Head Start and Head Start (EHS/HS) childcare centers. Methods: We conducted 19 semistructured qualitative interviews: 9 with childcare leadership and 10 with parents from EHS/HS childcare centers across Colorado. Interviews took place between April and December 2021. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti using a priori and emergent coding strategies. Descriptive content analysis was used to identify central themes, which were iteratively revised by 2 authors. Results: We derived 7 convergent and 4 divergent themes from leadership and parents addressing attendance decisions. Overlapping themes on barriers to adopting best practices included difficulty assessing symptom severity, limited medical provider understanding of childcare requirements, parent employment pressures, and the impact of the COVID-19 pandemic on exclusion durations. Leadership and parent perspectives differed on resources utilized, understanding of exclusionary symptoms, and role of medical providers in making attendance decisions. Overlapping themes on recommendations for best practices included access to registered nursing, concrete guidance on symptoms, and partnering with health departments. Leadership and parents agree that the COVID-19 pandemic led to increased guideline use in making attendance decisions and increased rates of excluding children from class for minor illness compared to prepandemic times. Both leadership and parents recommended consistency in exclusion practices, but leadership and parents identified medical providers and childcare leadership, respectively, as current sources of inconsistency. Salient findings showed variability in defining a fever by age from both leadership and parents. Conclusions: Coordination is needed between childcare centers, medical facilities, and health departments to improve attendance decisions for common pediatric illnesses. Future work should (1) develop concrete symptom guidance for parents with specific exclusion criteria (eg, via a decision aid), (2) assess the utility and feasibility of regular classroom access to registered nursing, and (3) advocate for employee protections to care for sick children at home.Funding: NoneDisclosures: None
Hospital-level variation in the utilization of antipseudomonal antibiotics: A nationwide cross-sectional study at the VHA
Authors: Hasegawa Shinya , Kakiuchi Satoshi , Livorsi Daniel , Perencevich Eli , Goto Michihiko 
Published: May 2022

Background: Avoiding unnecessary antipseudomonal coverage is 1 of the most common targets for antibiotic stewardship programs (ASPs), but little is known about the magnitude of facility-level variation in antipseudomonal agent utilization. We aimed to describe the variability in the use of antipseudomonal agents across inpatient settings within a nationwide integrated healthcare system. Method: We analyzed the data from a retrospective cohort of patients who were admitted to acute-care hospitals within the VHA system in 2019. We defined antipseudomonal agents as systemic antibiotics with activity against wild-type Pseudomonas aeruginosa, and we evaluated overall and antipseudomonal antibiotic use among 129 hospitals, according to the agents described in the NHSN Antimicrobial Usage and Resistance Module. We calculated each hospital’s overall and antipseudomonal days of therapy (DOT) per 1,000 days present and the proportion of antipseudomonal agent usage among all antibiotics based on DOT at each hospital. Hospital-level variation was assessed by comparing the proportion of total antibiotic consumption accounted for by antipseudomonal agents. Associations between antipseudomonal proportions and overall antibiotic consumption were also assessed. Results: Among 129 VHA hospitals, the median DOT per 1,000 days present for all antibiotics was 434.4 (IQR, 371.9–487.1), and the median antipseudomonal DOT per 1,000 days present was 127.7 (IQR, 99.8–159.6). The median proportion of total antibiotic consumption accounted for by antipseudomonal agents was 30.0% (range, 14.9%–40.7%; IQR, 26.4%–34.4%) (Fig. 1). We detected only a weak correlation between overall antibiotic consumption and antipseudomonal proportion (Pearson correlation coefficient, 0.396), which suggests that hospitals with higher total antibiotic consumption were not necessarily using more antipseudomonal agents. In a stratified analysis, there was more prominent hospital-level variability in surgical specialties than medical specialties (Fig. 2). Conclusions: We detected high hospital-level variability in the consumption and proportion of antipseudomonal antibiotics among an integrated healthcare system. Although it is plausible that these variabilities originated from case-mix differences among hospitals, including differing rates of P. aeruginosa infections, it may also highlight opportunities for reducing antipseudomonal antibiotic utilization, especially among surgical specialties. Further studies are needed to evaluate the contribution of modifiable patient- and facility-level factors to this variability.Funding: NoneDisclosures: None
Antimicrobial use patterns during the COVID-19 pandemic at an academic medical center
Authors: Pierce Jacob , Deja Erin , Lee Kimberly , Doll Michelle , Stevens Michael 
Published: May 2022

Background: The COVID-19 pandemic has made a significant impact on antimicrobial use patterns across health systems. We have described antibiotic use patterns at an academic medical center in Richmond, Virginia, before and after the onset of COVID-19. We also examined the impact on the proportional consumption of carbapenems (PoCC) metric. PoCC represents meropenem utilization relative to the narrower-spectrum antipseudomonal agents cefepime and piperacillin-tazobactam. Our institution practices antimicrobial restriction for meropenem. All other antibiotics included in the study data can be freely ordered by any provider. Methods: We evaluated antimicrobial use data from September 2018 through August 2021 using days of therapy (DOT) per 1,000 patient days. We included 18 months of data before and after the first recorded COVID-19 admission at our institution in March 2020. Mean comparisons were performed using the Welch 2-sample t test. The Bonferonni correction for multiple comparisons was utilized to determine significance with an initial baseline α of 0.05. All data analyses were performed using R software (R Foundation for Statistical Computing, Vienna, Austria, 2021). Results: Normality was evaluated with QQ-plots and all data demonstrated normality. Bonferroni correction produced an adjusted α value of 0.007. We detected significant increases in the use of cefepime, piperacillin-tazobactam, ceftriaxone, and azithromycin following the onset of the COVID-19 pandemic. We noted a significant decrease in the PoCC metric during this period. No significant change was noted for levofloxacin or meropenem. Conclusions: The COVID-19 pandemic produced significant changes in antimicrobial use patterns at our institution. We noted statistically significant increases in bacterial community-acquired pneumonia-focused antibiotics (ceftriaxone and azithromycin). We observed significant increases for cefepime and piperacillin-tazobactam. Interestingly, relative utilization of carbapenems as measured by the PoCC metric continued to decrease during this time. This trend was primarily driven by increases in cefepime and piperacillin-tazobactam utilization while meropenem utilization remained relatively constant. This study highlights the importance of looking at normalized antibiotic consumption data and not relative-use data alone.Funding: NoneDisclosures: None
Laughing through the Virus the Zimbabwean Way: WhatsApp Humor and the Twenty-one-day COVID-19 Lockdown
Authors: Chibuwe Albert , Munoriyarwa Allen 
Published: May 2022

AbstractIn many African countries, jokes represent one of the many means used by citizens to cope with a crisis. Chibuwe and Munoriyarwa explore how Zimbabweans utilize WhatsApp jokes, which are anchored in the concept of the “everyday,” to cope with pandemic-induced lockdowns. COVID-19 jokes provide citizens momentary relief from fear and function as a defense mechanism against COVID-19 and its effects, enabling citizens to confront and rationalize fear, death, and suffering. Chibuwe and Munoriyarwa argue that jokes are also a means of speaking truth to power by disgruntled citizens attempting to cope with a health crisis, in a context characterized by corruption, state repression, and bad governance.