Timothy C Jenkins1,2,3,4,5, Teresa Hulett6, Bryan C Knepper3, Katherine C Shihadeh7, Marc J Meyer8, Gerard R Barber9, John H Hammer10, Heidi L Wald4,6. 1. Department of Medicine, Denver Health, Aurora. 2. Division of Infectious Diseases, Denver Health, Aurora. 3. Department of Patient Safety and Quality, Denver Health, Aurora. 4. Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora. 5. Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora. 6. Colorado Hospital Association, Englewood. 7. Department of Pharmacy, Denver Health, Cortez. 8. Infection Prevention and Clinical Pharmacy, Southwest Health System, Cortez. 9. Department of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora. 10. CarePoint Infectious Diseases, Denver, Colorado.
Abstract
Background: Colorado hospitals participated in a statewide collaborative to improve the management of inpatient urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). We evaluated the effects of the intervention on diagnostic accuracy and antibiotic use. Methods: The main collaborative outcomes were proportion of UTI diagnoses that met criteria for symptomatic UTI; exposure to fluoroquinolones (UTI only); duration of therapy (UTIs and SSTIs); and exposure to antibiotics with broad gram-negative activity (SSTIs only). Outcomes were compared between pre-intervention and intervention periods overall and by hospital. Secondary analyses were changes in outcome trends by time series analysis. Results: Twenty-six hospitals, including 9 critical access hospitals, participated in the collaborative. Data were reported for 4060 UTIs and 1759 SSTIs. Between the pre-intervention and intervention periods, the proportion of diagnosed UTIs that met criteria for symptomatic UTI was similar (51% vs 54%, respectively; P = .10), exposure to fluoroquinolones declined (49% vs 41%; P < .001), and the median duration of therapy was unchanged (7 vs 7 days; P = .99). Among SSTIs, exposure to antibiotics with broad gram-negative activity declined (61% vs 53%; P = .001) and the median duration of therapy declined (11 vs 10 days; P = .03). There was substantial variation in performance among hospitals. By time series analysis, only the declining trend of fluoroquinolone use was significant (P = .03). Conclusions: The collaborative model is a feasible approach to engage hospitals in a common antibiotic stewardship intervention. Performance improvement was observed for several outcomes but varied substantially by hospital.
Background: Colorado hospitals participated in a statewide collaborative to improve the management of inpatient urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). We evaluated the effects of the intervention on diagnostic accuracy and antibiotic use. Methods: The main collaborative outcomes were proportion of UTI diagnoses that met criteria for symptomatic UTI; exposure to fluoroquinolones (UTI only); duration of therapy (UTIs and SSTIs); and exposure to antibiotics with broad gram-negative activity (SSTIs only). Outcomes were compared between pre-intervention and intervention periods overall and by hospital. Secondary analyses were changes in outcome trends by time series analysis. Results: Twenty-six hospitals, including 9 critical access hospitals, participated in the collaborative. Data were reported for 4060 UTIs and 1759 SSTIs. Between the pre-intervention and intervention periods, the proportion of diagnosed UTIs that met criteria for symptomatic UTI was similar (51% vs 54%, respectively; P = .10), exposure to fluoroquinolones declined (49% vs 41%; P < .001), and the median duration of therapy was unchanged (7 vs 7 days; P = .99). Among SSTIs, exposure to antibiotics with broad gram-negative activity declined (61% vs 53%; P = .001) and the median duration of therapy declined (11 vs 10 days; P = .03). There was substantial variation in performance among hospitals. By time series analysis, only the declining trend of fluoroquinolone use was significant (P = .03). Conclusions: The collaborative model is a feasible approach to engage hospitals in a common antibiotic stewardship intervention. Performance improvement was observed for several outcomes but varied substantially by hospital.
Authors: Jesse D Sutton; Ronald Carico; Muriel Burk; Makoto M Jones; XiangMing Wei; Melinda M Neuhauser; Matthew Bidwell Goetz; Kelly L Echevarria; Emily S Spivak; Francesca E Cunningham Journal: Open Forum Infect Dis Date: 2020-01-27 Impact factor: 3.835
Authors: Valerie M Vaughn; Lindsay A Petty; Scott A Flanders; Anurag N Malani; Twisha Patel; Steven J Bernstein; Lama M Hsaiky; Rama Thyagarajan; Danielle Osterholzer; Elizabeth McLaughlin; Jennifer K Horowitz; Tejal N Gandhi Journal: Open Forum Infect Dis Date: 2020-01-11 Impact factor: 3.835
Authors: Valerie M Vaughn; Tejal N Gandhi; Timothy P Hofer; Lindsay A Petty; Anurag N Malani; Danielle Osterholzer; Lisa E Dumkow; David Ratz; Jennifer K Horowitz; Elizabeth S McLaughlin; Tawny Czilok; Scott A Flanders Journal: Clin Infect Dis Date: 2022-08-31 Impact factor: 20.999