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Barriers to antibiotic stewardship at hospital discharge identified
Five barriers to better antibiotic decision-making at hospital discharge emerged after John Hopkins University School of Medicine researchers interviewed healthcare workers and discharged patients.
For the study, which was published yesterday in Infection Control and Hospital Epidemiology, the researchers conducted semistructured interviews with 37 healthcare workers and 16 discharged patients at a tertiary care hospital in Baltimore, Maryland. Their aim was to better understand antibiotic decision-making during the hospital-to-home transition and, how discharged patients manage their medication after leaving the hospital, and to identify barriers and strategies for improving discharge stewardship.
Most antibiotic courses initiated in hospitals are completed by patients after discharge, and previous research indicates that more than half of discharge prescriptions are of excessive duration, overly broad, or unnecessary.
The five main barriers identified through analysis of the interviews were (1) clinician perception of patient expectations for antibiotics, (2) diagnostic uncertainty, (3) a hierarchical culture led by the attending physician versus a multidisciplinary culture, (4) not accounting for in-hospital antibiotics when calculating the total antibiotic duration for discharged patients, and (5) organizational pressure for early discharge prior to the return of clinical and microbiologic data.
To address these barriers, the authors suggest that antimicrobial stewardship programs target hierarchical structures, differences in service cultures, and diagnostic uncertainty, and that the antibiotic decision-making system should account for the total duration of antibiotics to avoid prolonged courses of therapy.
“Implementation of targeted interventions can result in more effective outcomes for antibiotic use at the hospital-to-home transition,” they wrote.
Jan 21 Infect Control Hosp Epidemiol abstract
US Candida auris cases continue to climb
The number of confirmed and probable cases of Candida auris infection in the United States has risen to 1,625, according to an update this week from the Centers for Disease Control and Prevention (CDC).
Of the cases reported to the CDC as of Nov 30, 2020, 1,595 (98.2%) have been lab-confirmed and 30 (1.8%) are probable. An additional 3,172 patients have been found to be colonized with the multidrug-resistant yeast, as determined by targeted screening in 19 jurisdictions.
The number of states affected stands at 23, with New York (681), Illinois (411), New Jersey (202), California (117), and Florida (106) reporting the vast majority of cases. While many of the cases have been reported in long-term care facilities, the CDC notes that increased spread of C auris has been observed in acute care hospitals during the COVID-19 pandemic.
Since C auris was identified in 2009 in Japan, outbreaks have been reported in 31 countries, and 14 countries have reported single cases. C auris can cause serious invasive infections in immunocompromised patients, and it has shown resistance to three major antifungal drug classes. The CDC estimates that the mortality rate is anywhere from 30% to 60%.
Jan 19 CDC update