3 results
Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
- Kathleen Chiotos, Robert Grundmeier, Didien Meyahnwi, Lauren Dutcher, Ebbing Lautenbach, Melinda Neuhauser, Keith Hamilton, Anne Jaskowiak, Leigh Cressman, Julia Szymczak, Brandi Muller, Jeffrey Gerbe
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s106
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic use in hospitalized children and is a key target for pediatric antimicrobial stewardship programs (ASPs). Building upon prior work, we developed and refined an electronic algorithm to identify children hospitalized with CAP and to evaluate the appropriateness of initial antibiotic choice and duration. Methods: We performed a cross-sectional study including children 6 months to 17 years hospitalized for CAP between January 1, 2019, and October 31, 2022, at a tertiary-care children’s hospital. CAP was defined electronically as an International Classification of Disease, Tenth Revision (ICD-10) code for pneumonia, a chest radiograph or chest computed tomography scan (CT) performed within 48 hours of admission, and systemic antibiotics administered within the first 48 hours of hospitalization and continued for at least 2 days. We applied the following exclusion criteria: patients transferred from another healthcare setting, those who died within 48 hours of hospitalization, children with complex chronic conditions, and those with intensive care unit stays >48 hours. Criteria for appropriate antibiotic choice and duration were defined based on established guidelines. Two physicians performed independent medical record reviews of 80 randomly selected patients (10% sample) to evaluate the performance of the electronic algorithm in (1) identifying patients treated for clinician-diagnosed CAP and (2) classifying antibiotic choice and duration as appropriate. A third physician resolved discrepancies. The electronic algorithm was compared to this medical record review, which served as the reference standard. Results: Of 80 children identified by the electronic algorithm, 79 (99%) were diagnosed with CAP based on medical record review. Antibiotic use was classified as the appropriate choice in 75 (94%) of 80 cases, and appropriate duration in 16 (20%) of 80 cases. The sensitivity of the electronic algorithm for identifying appropriate initial antibiotic choice was 94%; specificity could not be calculated because no events of inappropriate antibiotic choice were identified based on chart review. The sensitivity and specificity for determining appropriate duration were 88% and 97%, respectively (Table 1).
Conclusions: The electronic algorithm accurately identified children hospitalized with CAP and demonstrated acceptable performance for identifying appropriate antibiotic choice and duration. Use of this electronic algorithm may improve the efficiency of stewardship activities and could facilitate alignment with updated accreditation standards. Future studies validating this algorithm at other centers are needed.
Disclosures: None
The Impact of Social Role Identity on Communication in Hospital-Based Antimicrobial Stewardship
- Julia Szymczak, Brandi Muller, Nikitha Shakamuri, Keith Hamilton, Elizabeth Dodds Ashley, Hilary Babcock, Rebekah Moehring, Jason Newland, Ebbing Lautenbach
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s14
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: Evidence-based hospital antimicrobial stewardship interventions, such as postprescription review with feedback, prior authorization, and handshake stewardship, involve communication between stewards and frontline prescribers. Hierarchy, asymmetric responsibility, prescribing etiquette, and autonomy can obstruct high-quality communication in stewardship. Little is known about the strategies that stewards use to overcome these barriers. The objective of this study was to identify how stewards navigate communication challenges when interacting with prescribers. Methods: We conducted semistructured interviews with antimicrobial stewards recruited from hospitals across the United States. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach and the framework method. Social identity theory and role theory were used to interpret framework matrices. Results: Interviews were conducted with 58 antimicrobial stewards (25 physicians and 33 pharmacists) from 10 hospitals (4 academic medical centers, 4 community hospitals, and 2 children’s hospitals). Respondents who felt empowered in their interactions with prescribers explicitly adopted a social identity that conceptualized stewards and prescribers as being on the “same team” with shared goals (in-group orientation). Drawing on the meaning conferred via this social role identity, respondents engaged in communication strategies to build and maintain common bonds with prescribers. These strategies included moderating language to minimize defensive recommendations when delivering stewardship recommendations, aligning the goals of stewardship with the goals of the clinical team, communicating with prescribers about things other than stewardship, compromising for the sake of future interactions, and engaging in strategic face-to-face interaction. Respondents who felt less empowered in their interactions thought of themselves as outsiders to the clinical team and experienced a heightened sense of “us versus them” mentality with the perception that stewards primarily serve a gate-keeping function (ie, outgroup orientation). These respondents expressed deference to hierarchy, a reluctance to engage in face-to-face interaction, a feeling of cynicism about the impact of stewardship, and a sense of low professional accomplishment within the role. Respondents who exhibited an in-group orientation were more likely than those who did not to describe the positive impact of stewardship mentors or colleagues on their social role identity. Conclusions: The way antimicrobial stewards perceive their role and identity within the social context of their healthcare organization influences how they approach communication with prescribers. Social role identity in stewardship is shaped by the influence of mentors and colleagues, indicating the importance of supportive relationships for the development of steward skill and confidence.
Funding: No
Disclosures: None
Prescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and Clostridioides difficile infection
- Julia E. Szymczak, Brandi M. Muller, Nikitha Shankar Shakamuri, Keith W. Hamilton, Jeffrey S. Gerber, Maryrose Laguio-Vila, Ghinwa K. Dumyati, Scott K. Fridkin, Alice Y. Guh, Sujan C. Reddy, Ebbing Lautenbach, for the CDC Prevention Epicenters Program
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue 8 / August 2020
- Published online by Cambridge University Press:
- 29 May 2020, pp. 914-920
- Print publication:
- August 2020
-
- Article
- Export citation
-
Background:
Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.
Methods:We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.
Results:Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.
Conclusions:Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.