• Change in hospital antibiotic use and acquisition of multidrug resistant gram-negative organisms after the onset of coronavirus disease 2019

      Bork, J.T.; Leekha, S.; Claeys, K.; Seung, H.; Tripoli, M.; Amoroso, A.; Heil, E.L. (Cambridge University Press, 2020-12-10)
      Interrupted time series segmented regression was conducted to trend antibiotic use and multidrug-resistant Gram-negative (MDRGN) acquisition relative to COVID-19 in an academic hospital. Total and pneumonia antibiotic use increased after COVID-19 when compared to similar 2019 period. MDRGN acquisition increased 3% for every increase in positive COVID-19 test per week. Copyright 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
    • Dalbavancin Use in Vulnerable Patients Receiving Outpatient Parenteral Antibiotic Therapy for Invasive Gram-Positive Infections

      Bork, J.T.; Heil, E.L.; Berry, S. (Springer Healthcare, 2019)
      Introduction: Dalbavancin is approved for acute bacterial skin and skin structure infections (ABSSSIs) but offers a potential treatment option for complicated invasive gram-positive infections. Importantly, dalbavancin's real benefits may be in treating complicated infections in vulnerable patient populations, such as persons who inject drugs (PWID). Methods: A multicenter retrospective analysis was performed from March 2014 to April 2017 to assess 30- and 90-day clinical cure and adverse drug events (ADEs) in adult patients who received ? 1 dose of dalbavancin for a non-ABSSSI indication. Results: During the study period, 45 patients received dalbavancin, 28 for a non-ABSSSI indication. The predominant infections treated included osteomyelitis (46%), endovascular infection (25%) and uncomplicated bacteremia (14%). Half of the patients had positive Staphylococcus aureus in cultures, 29% methicillin resistant and 21% methicillin susceptible. Most patients were prescribed dalbavancin as sequential treatment with a median of 13.5 days of prior antibiotic therapy. The most common reason for choosing dalbavancin over standard therapy use was PWID (54%). Seven patients were lost to follow-up at day 30. Of the remaining evaluable patients, 30-day clinical cure was achieved in 15/21 (71%) patients. The most common reason for failure was lack of source control (4/6, 67%). At day 90, relapse occurred in two patients. Three patients had a potential dalbavancin-associated ADE: two patients with renal dysfunction and one patient with pruritus. Conclusions: This study demonstrates a possible role for dalbavancin in the treatment of non-ABSSSI invasive gram-positive infections in select vulnerable OPAT patients. Copyright 2019, The Author(s).
    • Effect of urine reflex culturing on rates of cultures and infections in acute and long-term care

      Bork, J.T.; Claeys, K.; Zhan, M.; Morgan, D.J. (Springer Nature, 2020)
      Background: Urine cultures are often positive in the absence of a urinary tract infection (UTI). Pyuria is generally considered necessary to diagnose a UTI. Problem: Urine cultures are often positive in the absence of UTI leading to unnecessary antibiotics. Methods: Quasi-experimental pre-post study of all patient urine cultures ordered in a VA acute care hospital, emergency department (ED), and two long-term care (LTC) facilities from August 2016 to August 2018. Urine cultures performed per 100 days were compared pre- (August 2016 to July 2017) versus post-intervention (August 2017 to August 2018) using interrupted time series negative binomial regression. Intervention: We examined whether reflexing to urine culture only if a urinalysis (UA) found greater than 10 WBC/hpf decreased urine culturing. Results: In acute-care, reflex culturing resulted in a 39% time series regression analysis adjusted decrease in the rate of cultures performed (pre-intervention, 3.6 cultures/100 days vs. Post-intervention, 1.8 cultures/100 days, p < 0.001). Pre-intervention, 29% (4/14) of Catheter-associated UTI (CAUTI) would not have been reported if reflex culturing was employed. In the ED, reflex culturing was associated with a 38% (p = 0.0015) regression analysis adjusted decrease in cultures, from 5.4/100 visits to 3.3/100 visits. In LTC, there was a small absolute, but regression analysis adjusted increase of 89% (p = 0.0018) in rates from (0.4/100 days to 0.5/100 days). Conclusion: In acute care and ED, urine reflex culturing decreased the number of urine cultures performed. A small absolute increase was seen between pre-post time periods in LTC. Reflex testing generally decreases cultures and may lead to more accurate diagnoses of CAUTI.