75 results on '"Amy L. Pakyz"'
Search Results
2. A Multicenter Analysis of Changes in Pediatric Antibiotic Susceptibilities Among Staphylococcus aureus and Pseudomonas aeruginosa Isolates: 2014–2018
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Jeremy S, Stultz, Emily, Benefield, Kelley R, Lee, Ferras, Bashqoy, and Amy L, Pakyz
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Research ,Pediatrics, Perinatology and Child Health ,Pharmacology (medical) ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses - Abstract
OBJECTIVE To describe antibiotic susceptibilities for Staphylococcus aureus and Pseudomonas aeruginosa among pediatric institutions in 2018. To assess correlations between antibiotic utilization and susceptibilities. METHODS Institutional antibiograms from 2018 were compiled among 13 institutions via a survey. Resistant pathogens and antibiotic days of therapy/1000 patient days (PD) were collected from 6 institutions over 5 years. Correlations were assessed as pooled data among all institutions and relative changes within individual institutions. RESULTS All 8552 S aureus isolates in 2018 were vancomycin susceptible and 40.1% were methicillin resistant (MRSA). Among MRSA, 96.3% and 78.8% were susceptible to trimethoprim/sulfamethoxazole and clindamycin, respectively. Pooled yearly MRSA/1000 PD decreased from 2014–2018 and correlated with pooled yearly decreases in vancomycin utilization (R = 0.983, p = 0.003). Institutional relative decreases in vancomycin utilization from 2014–2018 did not correlate with institutional relative decreases in MRSA susceptibility (R = −0.659, p = 0.16). Susceptibility to meropenem was 90.9% among 2315 P aeruginosa isolates in 2018. Antipseudomonal beta-lactam susceptibility ranged from 89.4% to 92.3%. Pooled yearly meropenem-resistant P aeruginosa/1000 PD and meropenem utilization did not significantly decrease over time or correlate (both p > 0.6). Institutional relative change in meropenem utilization from 2013–2017 correlated with the institutional relative change in P aeruginosa susceptibility to meropenem from 2014–2018 (Rs = −0.89, p = 0.019). CONCLUSIONS Among included institutions, the burden of MRSA decreased over time. Institutional MRSA prevalence did not consistently correlate with institutional vancomycin utilization. Institutional changes in meropenem utilization correlated with P aeruginosa susceptibility the following year. Pooled analyses did not illustrate this correlation, likely owing to variability in utilization between institutions.
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- 2022
3. A Payer Perspective of the Costs of Urinary Tract and Skin and Soft Tissue Infections in Adults with Diabetes and the Relationship to Oral Antidiabetic Medication Nonadherence
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Marianne Baernholdt, Mary Lynn Davis-Ajami, Jun Wu, and Amy L. Pakyz
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urinary system ,MEDLINE ,Pharmaceutical Science ,Pharmacy ,Medication Adherence ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Health care ,Diabetes Mellitus ,medicine ,Humans ,Hypoglycemic Agents ,030212 general & internal medicine ,Young adult ,Intensive care medicine ,Aged ,Retrospective Studies ,business.industry ,Soft Tissue Infections ,030503 health policy & services ,Health Policy ,Virginia ,Soft tissue ,Retrospective cohort study ,Health Care Costs ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Urinary Tract Infections ,Female ,Observational study ,0305 other medical science ,business - Abstract
Controlling costs and improving quality outcomes are important considerations of the triple aim in health care. Medication adherence to oral antidiabetic (OAD) medications is an outcome measure for those with diabetes. However, there is little research reporting the costs associated with OAD medication adherence among adults with diabetes and comorbid infections.To provide nationally representative cost and utilization estimates from a payer perspective of 2 common comorbid infections: urinary tract infection (UTI) and skin and soft tissue infection (SSTI) among adults with diabetes in relation to OAD medication nonadherence to quantify cost per outcome.A retrospective observational study for years 2010-2015 used longitudinal panel data in the public domain from the Medical Expenditure Panel Survey (MEPS). The study included individuals aged ≥ 18 years with diabetes (excluding gestational diabetes) who were prescribed OAD medications and then stratified by infection status, that is, without infection versus with UTI and/or SSTI. Outcomes measured included medication adherence, defined as medication possession ratio (MPR); treated prevalence of UTI and SSTI; and associated direct medical costs paid by insurers.4,633 adults with diabetes were included; of those, 12% reported a UTI or SSTI, with the weighted sample representing 2.2 million U.S. residents. The mean MPR was 0.61 and 0.63 in the infection and noninfection groups, respectively. Less than 35% in each group were adherent to OAD medications. Having a UTI or SSTI increased the adjusted total health expenses by 53.7% (In adults with diabetes, a UTI or SSTI diagnosis did not influence medication adherence to OAD medication but increased health care utilization and costs significantly.This study was supported by the Virginia Commonwealth University Presidential Research Quest Fund (PeRQ Fund). The authors have no financial conflicts of interest to disclose.
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- 2019
4. Research needs in antibiotic stewardship
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Pranita D. Tamma, Jessina C. McGregor, Edward Stenehjem, Michael S. Calderwood, Amy L. Pakyz, Lona Mody, Rebekah W. Moehring, Julia E. Szymczak, Andrew Morris, Daniel J Livorsi, and Scott K. Fridkin
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Microbiology (medical) ,Research design ,Epidemiology ,business.industry ,MEDLINE ,Inappropriate Prescribing ,Bacterial Infections ,Research needs ,Drug resistance ,Anti-Bacterial Agents ,Antimicrobial Stewardship ,Infectious Diseases ,Nursing ,Research Design ,Drug Resistance, Bacterial ,Humans ,Medicine ,Antibiotic Stewardship ,business - Published
- 2019
5. Adequacy of empiric gram-negative coverage for septic patients at an academic medical center
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Michael P. Stevens, DaleMarie Vaughan, Kimberly Lee, Shaina Bernard, and Amy L. Pakyz
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Male ,Epidemiology ,Antibiotics ,Levofloxacin ,0302 clinical medicine ,polycyclic compounds ,030212 general & internal medicine ,Cefepime ,Aged, 80 and over ,Academic Medical Centers ,0303 health sciences ,Health Policy ,Middle Aged ,Shock, Septic ,Anti-Bacterial Agents ,Piperacillin, Tazobactam Drug Combination ,Infectious Diseases ,Female ,Gentamicin ,medicine.drug ,Adult ,medicine.medical_specialty ,Combination therapy ,medicine.drug_class ,Microbial Sensitivity Tests ,Meropenem ,Sepsis ,Young Adult ,03 medical and health sciences ,Internal medicine ,Gram-Negative Bacteria ,medicine ,Humans ,Aged ,Retrospective Studies ,Piperacillin ,030306 microbiology ,business.industry ,Septic shock ,Virginia ,Public Health, Environmental and Occupational Health ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,medicine.disease ,Cephalosporins ,bacteria ,business - Abstract
Background Gram-negative organisms (GNOs) have increasing resistance rates to levofloxacin at Virginia Commonwealth University Health System (VCUHS), where levofloxacin is the most common agent added to provide double coverage of gram-negative infections. The goal of this study was to determine the adequacy of empiric gram-negative coverage for septic patients at our institution. Methods A retrospective review of patients admitted to VCUHS, from January 1, 2014, to December 31, 2014, with a diagnosis of sepsis, severe sepsis, or septic shock and documented infection, was performed to determine the adequacy of various empiric antibiotic combinations. Results Of 219 patients who met the inclusion criteria, 56% of patients received monotherapy and 21% of patients received combination therapy (2 antibiotics) covering GNOs. GNOs (84%) were susceptible to piperacillin-tazobactam. When used in combination with cefepime and meropenem, levofloxacin did not increase coverage. However, levofloxacin provided an 8% increase in coverage and gentamicin provided an additional 13% increase in coverage, respectively, when used in combination with piperacillin-tazobactam. Conclusions Among septic patients at VCUHS, gentamicin provided increased gram-negative coverage when compared with levofloxacin. Although susceptibility to piperacillin-tazobactam alone was relatively low, the combination of piperacillin-tazobactam and gentamicin provided nearly equivalent coverage to meropenem and gentamicin.
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- 2019
6. Changes in Metronidazole and Vancomycin Utilization for Nonsevere Clostridioides difficile Infection Among Institutions Caring for Children
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Nicole E Omecene, Jeremy S. Stultz, Amy L. Pakyz, Christine M. Orndahl, and Jaclyn Hopp
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Microbiology (medical) ,medicine.medical_specialty ,Adolescent ,MEDLINE ,Administration, Oral ,03 medical and health sciences ,0302 clinical medicine ,Vancomycin ,Metronidazole ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Oral metronidazole ,030212 general & internal medicine ,Child ,Oral vancomycin ,Clostridioides difficile ,business.industry ,Infant ,Drug Utilization ,Confidence interval ,Anti-Bacterial Agents ,Cross-Sectional Studies ,Infectious Diseases ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Clostridium Infections ,business ,Clostridioides ,medicine.drug - Abstract
Clostridioides difficile infection guidelines were published in final format on April 1, 2018. Among 4962 and 3545 C. difficile infection cases in children the year before and after publication, oral metronidazole use decreased from 63.0% to 44.3% (P < 0.001) and oral vancomycin use increased from 27.3% to 47.7% (P < 0.001). Quarterly metronidazole utilization decreased postguidelines among 117 institutions, incidence rate ratios 0.86 (95% confidence intervals: 0.78-0.96).
- Published
- 2021
7. Variability in antifungal utilization among neonatal, pediatric, and adult inpatients in academic medical centers throughout the United States of America
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Amy L. Pakyz, Jeremy S. Stultz, and Rose M. Kohinke
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Adult ,Male ,0301 basic medicine ,Antifungal ,medicine.medical_specialty ,Antifungal Agents ,medicine.drug_class ,030106 microbiology ,Antimicrobial stewardship ,Pediatrics ,lcsh:Infectious and parasitic diseases ,Immunocompromised Host ,03 medical and health sciences ,0302 clinical medicine ,Medical microbiology ,Internal medicine ,medicine ,Humans ,Antifungal stewardship ,lcsh:RC109-216 ,030212 general & internal medicine ,Patient group ,Antibiotic use ,Child ,Antimicrobial trends ,Academic Medical Centers ,Inpatients ,Hematology ,business.industry ,Infant ,Neonates ,Hospitals ,United States ,Anti-Bacterial Agents ,Pediatric patient ,Infectious Diseases ,Tropical medicine ,Female ,business ,Invasive Fungal Infections ,Research Article - Abstract
Background Identification of factors associated with antifungal utilization in neonatal, pediatric, and adult patient groups is needed to guide antifungal stewardship initiatives in academic medical centers. Methods For this hospital-level analysis, we analyzed antifungal use in hospitals across the United States of America, excluding centers only providing care for hematology/oncology patients. Analysis of variance was used to compare antifungal use between patient groups. Three multivariable linear regression models were used to determine independent factors associated with antifungal use in the neonatal, pediatric, and adult patient groups. Results For the neonatal, pediatric, and adult patient groups, 54, 44, and 60 hospitals were included, respectively. Total antifungal use was significantly lower in the neonatal patient group (14 days of therapy (DOT)/1000 patient days (PDs) versus 76 in pediatrics and 74 in adults, p
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- 2018
8. Economic burden of pediatric prescription opioid poisonings in the United States
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Amy L. Pakyz, Anisha M. Patel, S. Rutherfoord Rose, David C. Wheeler, Pramit Nadpara, Norman V. Carroll, and Stephen C Ijioma
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medicine.medical_specialty ,Injury control ,business.industry ,Health Policy ,Poisoning ,Child Health Services ,food and beverages ,Pharmaceutical Science ,Human factors and ergonomics ,Poison control ,Pharmacy ,Suicide prevention ,Occupational safety and health ,United States ,Analgesics, Opioid ,Opioid ,Cost of Illness ,Prescription opioid ,Injury prevention ,Emergency medicine ,Medicine ,Humans ,business ,Child ,medicine.drug - Abstract
BACKGROUND: Among the different drugs involved in pediatric exposures and poisonings, opioids are the most important, given their rise in nonmedical use. Opioid poisonings in children can result in...
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- 2020
9. Educational Outcomes Resulting From Restructuring a Scholarship Course for Doctor of Pharmacy Students
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Katherine Henderson, Teresa M. Salgado, Amy L. Pakyz, Leticia R. Moczygemba, Julie A. Patterson, Benjamin W. Van Tassell, Kai I. Cheang, Jeremy S. Stultz, and MaryPeace McRae
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Restructuring ,education ,Pharmacy ,030226 pharmacology & pharmacy ,Education ,03 medical and health sciences ,0302 clinical medicine ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Learning ,030212 general & internal medicine ,Sociology ,General Pharmacology, Toxicology and Pharmaceutics ,Fellowships and Scholarships ,Curriculum ,Medical education ,business.industry ,Research ,Reproducibility of Results ,General Medicine ,Education, Pharmacy, Graduate ,Faculty ,Scholarship ,Students, Pharmacy ,Commonwealth ,Educational Measurement ,business ,Pharmacy research - Abstract
Objective. To compare educational outcomes between two iterations of a scholarship and research course for Doctor of Pharmacy (PharmD) students at Virginia Commonwealth University’s School of Pharmacy. Methods. The first iteration of a course intended to teach pharmacy students the knowledge and skills necessary to design and conduct research involved lectures and application exercises, including limited guided questions about different aspects of the research process. In the fall of 2015, multiple structured activities and accompanying grading rubrics, each designed around the structure and content of a section of a research proposal, were introduced to the course to supplement lectures. Both iterations of the course culminated with students submitting a research proposal. After establishing interrater reliability, faculty members graded a random sample of 20 research proposals, 10 from each version of the course, and section-specific and overall proposal scores were compared. Results. In the proposals submitted after the course revisions, significant improvements in three areas were identified: the overall score, the section-specific scores for research hypothesis/specific aims, and institutional review board (IRB) discussion/informed consent. Nominal, though not statistically significant, improvements were observed in other sections. Conclusion. Additional research is needed regarding the best instructional strategies to reinforce data analysis and statistical testing knowledge and skills in PharmD students. Overall, our findings support the hypothesis that a more formalized, guided approach for teaching research methods improves learning outcomes for PharmD students.
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- 2019
10. Impact of the Centers for Medicare and Medicaid Services Sepsis Core Measure on Antibiotic Use
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Samuel F. Hohmann, Michael P. Stevens, Christine M. Orndahl, Gonzalo Bearman, Alicia Johns, Daniel J. Morgan, David W. Harless, and Amy L. Pakyz
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Microbiology (medical) ,Adult ,Methicillin-Resistant Staphylococcus aureus ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,medicine.disease_cause ,Medicare ,Centers for Medicare and Medicaid Services, U.S ,Sepsis ,03 medical and health sciences ,Surgical prophylaxis ,0302 clinical medicine ,Internal medicine ,medicine ,Antimicrobial stewardship ,Humans ,030212 general & internal medicine ,Antibiotic use ,Aged ,Cross Infection ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,United States ,Anti-Bacterial Agents ,Infectious Diseases ,Staphylococcus aureus ,business ,Medicaid ,Clostridioides - Abstract
Background The Centers for Medicare and Medicaid Services (CMS) implemented a core measure sepsis (SEP-1) bundle in 2015. One element was initiation of broad-spectrum antibiotics within 3 hours of diagnosis. The policy has the potential to increase antibiotic use and Clostridioides difficile infection (CDI). We evaluated the impact of SEP-1 implementation on broad-spectrum antibiotic use and CDI occurrence rates. Methods Monthly adult antibiotic data for 4 antibiotic categories (surgical prophylaxis, broad-spectrum for community-acquired infections, broad-spectrum for hospital-onset/multidrug-resistant [MDR] organisms, and anti–methicillin-resistant Staphylococcus aureus [MRSA]) from 111 hospitals participating in the Clinical Data Base Resource Manager were evaluated in periods before (October 2014–September 2015) and after (October 2015–June 2017) policy implementation. Interrupted time series analyses, using negative binomial regression, evaluated changes in antibiotic category use and CDI rates. Results At the hospital level, there was an immediate increase in the level of broad-spectrum agents for hospital-onset/MDR organisms (+2.3%, P = .0375) as well as a long-term increase in trend (+0.4% per month, P = .0273). There was also an immediate increase in level of overall antibiotic use (+1.4%, P = .0293). CDI rates unexpectedly decreased at the time of SEP-1 implementation. When analyses were limited to patients with sepsis, there was a significant level increase in use of all antibiotic categories at the time of SEP-1 implementation. Conclusions SEP-1 implementation was associated with immediate and long-term increases in broad-spectrum hospital-onset/MDR organism antibiotics. Antimicrobial stewardship programs should evaluate sepsis treatment for opportunities to de-escalate broad therapy as indicated.
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- 2019
11. Effect of carbapenem restriction on prescribing trends for immunocompromised wards at an academic medical center
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Oveimar De La Cruz, Michelle Doll, Jacob Pierce, Gonzalo Bearman, Jihye Kim, Michael P. Stevens, Kimberly Lee, Amy L. Pakyz, D. Markley, and Andrew Kirk
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medicine.medical_specialty ,Bone marrow transplant ,Carbapenem ,Epidemiology ,Meropenem ,Interrupted Time Series Analysis ,Antimicrobial Stewardship ,Immunocompromised Host ,03 medical and health sciences ,0302 clinical medicine ,Drug Resistance, Multiple, Bacterial ,polycyclic compounds ,medicine ,Humans ,Antimicrobial stewardship ,Center (algebra and category theory) ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Formulary ,Academic Medical Centers ,0303 health sciences ,030306 microbiology ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Bacterial Infections ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,Drug Utilization ,Hospitals ,Anti-Bacterial Agents ,Infectious Diseases ,Emergency medicine ,bacteria ,Guideline Adherence ,business ,Hematology+Oncology ,medicine.drug - Abstract
The recently described proportion of carbapenem consumption metric was used to assess the effectiveness of formulary restriction for carbapenems for 2 units housing predominantly immunocompromised patients at a large academic medical center. Interrupted time series analysis revealed a significant decrease in meropenem use for hematology-oncology and bone marrow transplant units after restriction.
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- 2019
12. The effectiveness of formulary restriction and preauthorization at an academic medical center
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Jacob Pierce, Michelle Doll, Amy L. Pakyz, Michael P. Stevens, Jihye Kim, J. Daniel Markley, Kimberly Lee, Andrew Kirk, and Gonzalo Bearman
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Academic Medical Centers ,medicine.medical_specialty ,Epidemiology ,business.industry ,Health Policy ,Virginia ,Public Health, Environmental and Occupational Health ,Bacterial Infections ,Drug Prescriptions ,Formularies, Hospital as Topic ,Prior Authorization ,Drug Utilization ,Anti-Bacterial Agents ,Antimicrobial Stewardship ,Infectious Diseases ,Emergency medicine ,medicine ,Humans ,Antimicrobial stewardship ,Medical prescription ,Formulary ,business - Abstract
The impact of formulary restriction and preauthorization (FRPA) on prescribing trends was examined over a 5-year period at an academic medical center. Ordinary least squares regression was used to identify hospital units demonstrating statistically significant trends in prescription of restricted agents. Significant decreases in restricted drug use were seen on 2 of 7 medicine units subject to FRPA, whereas a significant increase was seen in 1 of 4 surgical units subject to FRPA.
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- 2019
13. High-risk medication use for Clostridium difficile infection among hospitalized patients with cancer
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Resa M. Jones, Samuel F. Hohmann, Amy L. Pakyz, Phuong Opper, Rose M. Kohinke, and Pramit Nadpara
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,genetic structures ,Risk medication ,Epidemiology ,Hospitalized patients ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Drug Therapy ,Neoplasms ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Academic Medical Centers ,Inpatients ,0303 health sciences ,030306 microbiology ,business.industry ,Incidence ,Health Policy ,Public Health, Environmental and Occupational Health ,Cancer ,Middle Aged ,Clostridium difficile ,medicine.disease ,Cross-Sectional Studies ,Infectious Diseases ,Clostridium Infections ,Female ,Oncology patients ,business - Abstract
Patients with cancer are vulnerable to Clostridium difficile infection (CDI); hospitals with larger oncology populations may have worse CDI performance. Among 71 academic hospitals studied, there were significant differences in oncology patient-days per 1,000 admissions across CDI standardized infection ratio categories of better, no different, and worse; worse hospitals had the greatest number of patient-days. Oncology patients' most commonly used high-risk CDI medications were quinolones, third- and fourth-generation cephalosporins, and proton pump inhibitors.
- Published
- 2019
14. Virtual Pediatric Patient Activities With Randomized Scenarios as an Instructional Tool for Pharmacy Students
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Michael Forder, Jeremy S. Stultz, and Amy L Pakyz
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medicine.medical_specialty ,020205 medical informatics ,business.industry ,Clinical Investigations ,Educational technology ,Pharmacy ,02 engineering and technology ,medicine.disease ,Test (assessment) ,03 medical and health sciences ,Pediatric patient ,0302 clinical medicine ,Virtual patient ,Pediatrics, Perinatology and Child Health ,Active learning ,0202 electrical engineering, electronic engineering, information engineering ,Mann–Whitney U test ,Physical therapy ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,business ,Asthma - Abstract
OBJECTIVES To assess student pharmacist best activity scores and related exam question performance based on the number of pediatric virtual patient activity (VPA) attempts. METHODS A 40-point asthma VPA was implemented and included three possible randomized scenarios. A 60-point meningitis VPA was implemented and included three possible randomized scenarios followed by an additional three possible randomized scenarios only if the first scenario was correctly completed. Points were awarded in the VPA based on appropriateness of treatment decisions. Students were allowed unlimited VPA attempts individually and as a group in class. Three exam questions were based on a fourth scenario of each randomized portion of the VPAs. The Kruskal-Wallis test, Mann-Whitney U test, and T-test were used for statistical comparisons when appropriate. RESULTS Of 132 students, median individual best asthma VPA scores were 15.25, 22, and 30 for those with 1, 2, and ≥3 asthma attempts, respectively (p < 0.001). Median individual best meningitis VPA scores were 4, 5, 7, and 45.5 for those with 1, 2, 3 to 4, and ≥5 attempts, respectively (p < 0.001). Median number of group VPA attempts was higher among students who correctly answered the exam question related to the first randomized meningitis scenario (10 versus 4, p = 0.015), although no differences in attempts were found for the other related questions (all p > 0.05). CONCLUSIONS Students who completed the VPAs more times achieved greater individual best scores. Students who correctly answered related exam questions had a higher number of group VPA attempts only when continuation of the VPA required correct randomized scenario completion.
- Published
- 2017
15. Leapfrog Hospital Safety Score, Magnet Designation, and Healthcare-Associated Infections in United States Hospitals
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Timothy J. Vogus, Yasar A. Ozcan, Michael B. Edmond, Amy L. Pakyz, and Hui Wang
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Methicillin-Resistant Staphylococcus aureus ,Healthcare associated infections ,medicine.medical_specialty ,Leadership and Management ,MEDLINE ,Ordered probit ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Bloodstream infection ,Health care ,medicine ,Humans ,Infection control ,030212 general & internal medicine ,Intensive care medicine ,Cross Infection ,030504 nursing ,business.industry ,Confounding ,Public Health, Environmental and Occupational Health ,Staphylococcal Infections ,Hospitals ,United States ,Emergency medicine ,0305 other medical science ,business ,Delivery of Health Care - Abstract
OBJECTIVE Healthcare-associated infections (HAIs) pose a challenge to patient safety. Although studies have explored individual level, few have focused on organizational factors such as a hospital's safety infrastructure (indicated by Leapfrog Hospital Safety Score) or workplace quality (Magnet recognition). The aim of the study was to determine whether Magnet and hospitals with better Leapfrog Hospital Safety Scores have fewer HAIs. METHODS Ordered probit regression analyses tested associations between Safety Score, Magnet status, and standardized infection ratios, depicting whether a hospital had a Clostridium difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection standardized infection ratio that was "better," "no different," or "worse" than a National Benchmark as per Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. RESULTS Accounting for confounders, relative to "A" hospitals, "B" and "C" hospitals had significant and negative relationships with CDI (-0.16, P < 0.01, and -0.14, P < 0.05, respectively) but not MRSA bacteremia. Magnet hospitals had a significant and positive relationship with MRSA bloodstream infections (0.74, P < 0.001) but a significant negative relationship with CDI (-0.21, P < 0.01) compared with non-Magnet. CONCLUSIONS A hospitals performed better on CDI but not MRSA bloodstream infections. In contrast, Magnet designation was associated with fewer than expected MRSA infections but more than expected CDIs. These mixed results indicate that hospital global assessments of safety and workplace quality differentially and imperfectly predict its level of HAIs, suggesting the need for more precise organizational measures of safety and more nuanced approaches to infection prevention and reduction.
- Published
- 2017
16. A survey to optimize the design of an antimicrobial stewardship smartphone app at an academic medical center
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Nital P Appelbaum, Michael P. Stevens, Gonzalo Bearman, Amy L. Pakyz, J. Daniel Markley, Kimberly Lee, and Shaina Bernard
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Adult ,Male ,020205 medical informatics ,Epidemiology ,02 engineering and technology ,Communicable Diseases ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,mental disorders ,Health care ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,Antimicrobial stewardship ,Medicine ,Center (algebra and category theory) ,Mobile technology ,030212 general & internal medicine ,Academic Medical Centers ,Infection Control ,Medical education ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Middle Aged ,Mobile Applications ,Drug Utilization ,Organizational Policy ,Anti-Bacterial Agents ,Infectious Diseases ,Smartphone app ,Female ,Guideline Adherence ,Smartphone ,business - Abstract
Mobile medical apps are commonly used by health care professionals and could be used by antimicrobial stewardship programs to enhance adherence to local recommendations. We conducted a survey of health care workers to inform the design of an antimicrobial stewardship smartphone app.
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- 2017
17. Enhancing the Utility of Antibiotic Susceptibility Reporting as a Tool for Antimicrobial Stewardship
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Jessina C. McGregor and Amy L. Pakyz
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0301 basic medicine ,Cultural Studies ,Linguistics and Language ,History ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Narrow spectrum ,Language and Linguistics ,Antibiotic prescribing ,03 medical and health sciences ,Clinical microbiology ,0302 clinical medicine ,Antibiogram ,030225 pediatrics ,Anthropology ,Antibiotic therapy ,Medicine ,Antimicrobial stewardship ,business ,Intensive care medicine - Abstract
Hospital antibiograms are a method for presenting cumulative antibiotic susceptibility data using routinely collected clinical microbiology data. They provide critical foundational knowledge to inform development of antimicrobial stewardship program (ASP) strategies but are also provided to clinicians to inform empiric antibiotic therapy selection. Earlier research has demonstrated that use of the antibiogram to direct prudent antibiotic selection is less than desired. Use by non-infectious disease practitioners has been limited, and antibiotic prescribing has not aligned with ASP goals. Over the past 5 years, newer research has emerged to increase the utility of the antibiogram through education, stratification, and cross-tabulation of data for combination therapy. These approaches focus on increasing use of the cumulative antibiogram and ensuring that the data appropriately influence the antibiotic therapy selection. Data available to date suggest that these strategies can be effective methods of increasing use of concordant and relatively narrow spectrum empiric antibiotic regimens.
- Published
- 2017
18. Association between meeting core elements for inpatient antimicrobial stewardship and antibiotic utilization
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Shaina Bernard, Michael P. Stevens, Samuel F. Hohmann, Amy L. Pakyz, Kristi Kuper, Natalie Nguyen, and Kimberly Lee
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Microbiology (medical) ,Adult ,medicine.medical_specialty ,Meticillin ,Epidemiology ,medicine.drug_class ,Antibiotics ,Drug resistance ,Antimicrobial Stewardship ,Pharmacotherapy ,Internal medicine ,Surveys and Questionnaires ,medicine ,Antimicrobial stewardship ,Humans ,Core (anatomy) ,Cross Infection ,Inpatients ,business.industry ,Staphylococcal Infections ,United States ,Anti-Bacterial Agents ,Community-Acquired Infections ,Infectious Diseases ,Cross-Sectional Studies ,Multicenter study ,business ,medicine.drug ,Beta lactam antibiotics - Abstract
We used multivariable analyses to assess whether meeting core elements was associated with antibiotic utilization. Compliance with 7 elements versus not doing so was associated with higher use of broad-spectrum agents for community-acquired infections [days of therapy per 1,000 patient days: 155 (39) vs 133 (29), P = .02] and anti-methicillin-resistant S. aureus agents [days of therapy per 1,000 patient days: 145 (37) vs 124 (30), P = .03].
- Published
- 2019
19. Learning Activities to Build Population Health Management Skills for Pharmacy Students
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Amy L. Pakyz, Leticia R. Moczygemba, Kai I. Cheang, and Jeremy S. Stultz
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Program evaluation ,education ,050801 communication & media studies ,Pharmacy ,Population health ,Education ,03 medical and health sciences ,0508 media and communications ,0302 clinical medicine ,Humans ,030212 general & internal medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Medical education ,business.industry ,Research ,05 social sciences ,General Medicine ,Problem-Based Learning ,Students, Pharmacy ,Education, Pharmacy ,Pharmaceutical Services ,Population Health Management ,Educational Measurement ,business ,Psychology ,Program Evaluation - Abstract
Objective. To describe the implementation and evaluation of population health management learning activities in a second-year Doctor of Pharmacy (PharmD) course.Methods. Population health learning ...
- Published
- 2018
20. 142. Frequency of Short-course Empiric Antibiotic Use as an Antimicrobial Stewardship Metric
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Amy L. Pakyz, Caitlin M McCracken, Jessina C. McGregor, and Samuel F. Hohmann
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medicine.medical_specialty ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,business.industry ,Poster Abstracts ,medicine ,Antimicrobial stewardship ,Short course ,Metric (unit) ,Antibiotic use ,Intensive care medicine ,business - Abstract
Background Antimicrobial stewardship metrics that provide actionable guidance are needed to support efforts to improve hospital use of antibiotics. Antibiotics such as vancomycin and piperacillin/tazobactam are common empiric agents used frequently when the infectious process remains unknown. Thus short, incomplete courses of therapy are used more frequently for such agents. We aimed to evaluate the variability in short courses of vancomycin and piperacillin/tazobactam use across U.S. hospitals. Methods We performed a cross-sectional study among U.S. hospitals that contributed inpatient pharmacy data to the Vizient clinical database in 2016. We identified vancomycin and piperacillin-tazobactam courses initiated within the 48 hours of admission, measured as days of therapy received. We calculated the percent of patients that received 1, 2, 3, 4 or >4 days of therapy at each facility to describe short course empiric therapy use. To describe the variability across facilities, we then assessed the median, interquartile range (IQR), and total range of that percentage. Results We identified 145 hospitals representing approximately 3.7 million patient encounters for inclusion in this study. Within 48 hours of admission, 13.9% of encounters received vancomycin, 7.7% piperacillin/tazobactam, and 4.6% received both. The figure demonstrates the variability in the frequency of short course antibiotic use across hospitals; boxes indicate the IQR with the transecting line representing the median and whiskers representing the full range. The proportion of patients that received one day of therapy varied most across hospitals, with vancomycin ranging from 0–100%. In contrast, the frequency of patients that received greater than four days of therapy varied considerably less across hospitals; 0–33% for vancomycin. Conclusion The variability in use of short course empiric therapies suggests that use for non-infectious processes or infections not appropriately treated by these agents varies greatly across facilities. Measuring short course use for common empiric agents may serve as an important antimicrobial stewardship metric. Such a metric could inform antimicrobial stewardship efforts to reduce unnecessary initiation of empiric antimicrobial therapy. Disclosures All Authors: No reported disclosures
- Published
- 2020
21. Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit
- Author
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Emily Godbout, Kimberly Lee, Andrew J. Noda, Aline Le, Amy L. Pakyz, Gonzalo Bearman, John Daniel Markley, Jihye Kim, Michael P. Stevens, Michelle Doll, and Le Kang
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Infectious Diseases ,Epidemiology ,Order (business) ,business.industry ,Medical intensive care unit ,Emergency medicine ,medicine ,business ,Administration (government) ,Meropenem ,medicine.drug - Abstract
Background: In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewardship program (ASP) at Virginia Commonwealth University Health System (VCUHS) requires approval for restricted antimicrobial orders placed between 8 a.m. and 9 p.m. Between 8 a.m. and 5 p.m. (daytime), authorized approvers include ASP and infectious diseases (ID) physicians. From 5 p.m. to 9 p.m. (evening) orders are approved by ID fellows. Orders were entered as Stat, Now, and Routine. Between 9 p.m. and 8 a.m. (night), patients receive doses without approval. Meropenem restriction began in mid-January 2018. Pre- and postmeropenem restriction periods were defined as February–December 2017 and February–December 2018. Meropenem use data were compared for adult patients in the MICU. A multivariable Cox regression model was implemented to compare (1) time from order entry to approval; (2) time from order approval to patient administration; (3) total time from order entry to patient administration, adjusting for order priority, approver (ASP, ID consult, ID fellow, pharmacy); and (4) time of day of order placement (day, eve, night). The analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Result: Time from order approval to patient administration was significantly decreased in the postrestriction period (HR, 1.840; P < .001) (Table 1). Stat orders were faster compared to routine orders for order entry to approval (HR, 1.735; P < .001), approval to administration (HR, 2.610; P < .001), and total time from order entry to administration (HR, 2.812; P < .001). No significant differences were found in time to approval by approving service. Time from order entry to approval was faster for nighttime orders than for daytime orders (HR, 1.399; P = .037). Conclusions: Our data indicate that the time from order entry to administration decreased following meropenem restriction in our MICU. More research is needed to identify the reason for this finding, but we postulate that this is due to an effect on drug administration prioritization within nursing workflow. These data will inform our local meropenem restriction efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.
- Published
- 2020
22. 232. Impact of Weekend Initiation of Vancomycin or Piperacillin/Tazobactam on Days of Therapy Received upon Hospital Admission
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Amy L. Pakyz, Caitlin M McCracken, Samuel F. Hohmann, and Jessina C. McGregor
- Subjects
medicine.medical_specialty ,business.industry ,education ,Pharmacy ,AcademicSubjects/MED00290 ,Infectious Diseases ,Pharmacy (field) ,Oncology ,Antibiotic therapy ,Poster Abstracts ,Hospital admission ,Emergency medicine ,Piperacillin/tazobactam ,medicine ,Vancomycin ,business ,human activities ,medicine.drug - Abstract
Background Antibiotic therapy for inpatients with suspected infections is typically empirically initiated and therapy narrowed or altered when additional diagnostic evidence becomes available. For patients whose therapy is initiated on a weekend, differences in hospital staffing may impact the timing of therapy changes. We aimed to compare the duration of therapy of vancomycin and piperacillin-tazobactam between those who had therapy initiated on a weekday versus a weekend day. Methods We performed a cross-sectional study among U.S. hospitals that contributed pharmacy data for inpatients to the Vizient clinical database in 2016. We identified vancomycin and piperacillin-tazobactam courses initiated within the first 48 hours of admission; courses were categorized as weekend initiation (Friday, Saturday, Sunday) versus weekday initiation. The median days of therapy were compared between weekend and weekday initiation using the Wilcoxon rank-sum test. Results Among the 145 hospitals representing approximately 3.7 million patient encounters there were 401,101 encounters with vancomycin and 221,751 with piperacillin/tazobactam initiated within the first 48 hours of admission. Of these courses, 33% of vancomycin and 40% of piperacillin/tazobactam were initiated on a weekend day. The median (IQR) days of therapy for vancomycin initiated on a weekend was 2 days (1–4 days) compared to 2 days (1–3 days) when initiated on a weekday (p< .01). The median (IQR) days of therapy for piperacillin/tazobactam was 3 days (2–5 days) for courses initiated on either a weekend or weekday (p< .01). Conclusion We observed a statistically significant difference in the days of therapy received by patient encounters with vancomycin or piperacillin/tazobactam initiated on weekdays versus weekends. However, because of the large sample size in this study, we had power to identify small differences as statistically significant. Still, for vancomycin the 75th percentile received at least one additional day of therapy when initiated on a weekend versus a weekday. Further exploration is needed to identify if weekend initiation is associated with extended durations of therapy in specific sub-populations of patients. Disclosures All Authors: No reported disclosures
- Published
- 2020
23. Antimicrobial Stewardship Program Members’ Perspectives on Program Goals and National Metrics
- Author
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Amy L. Pakyz, Jacob Van Parys, Leticia R. Moczygemba, and Michael P. Stevens
- Subjects
0301 basic medicine ,Pharmacology ,Knowledge management ,business.industry ,030106 microbiology ,Environmental resource management ,030501 epidemiology ,03 medical and health sciences ,Anti-Infective Agents ,Content analysis ,Humans ,Medicine ,Antimicrobial stewardship ,Pharmacology (medical) ,Metric (unit) ,0305 other medical science ,business ,Goals - Abstract
Purpose This study compares antimicrobial stewardship program (ASP)–stated goals and outcomes collected as well as opinions regarding national metric establishment. Methods Twenty-one ASP members underwent telephone interviews answering open-ended questions about ASP goals, outcomes collected, and opinions about national metrics. Content analysis was used to code responses into predefined ASP-metric categories. Findings The most common ASP goal was antimicrobial appropriateness (76%), outcomes tracked were use and microbial outcomes (both 71%), and desired national metric was use (67%). Implications Stated-goals, outcomes tracked, and opinions regarding national metric establishment did not fully align. With ASP-related regulations looming, it is important that alignment is increased.
- Published
- 2016
24. Fecal microbiota transplantation for recurrent Clostridium difficile infection: The patient experience
- Author
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Leticia R. Moczygemba, Amy L. Pakyz, Michael B. Edmond, and Lynn M. VanderWielen
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Epidemiology ,media_common.quotation_subject ,Interviews as Topic ,Young Adult ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Patient satisfaction ,Weight loss ,Patient experience ,Secondary Prevention ,Humans ,Medicine ,030212 general & internal medicine ,Young adult ,Child ,Aged ,media_common ,Aged, 80 and over ,Clostridioides difficile ,business.industry ,Information seeking ,Health Policy ,Public Health, Environmental and Occupational Health ,Fecal Microbiota Transplantation ,Middle Aged ,Treatment Outcome ,Infectious Diseases ,Feeling ,Patient Satisfaction ,Clostridium Infections ,Quality of Life ,Physical therapy ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Qualitative research - Abstract
Background Although effectiveness of fecal microbiota transplantation (FMT) has been adequately documented, the patient experience of undergoing FMT has not. Methods We carried out a qualitative interview study using semistructured questions relating to aspects of health pre-FMT, during FMT, and post-FMT periods with 17 participants. Inductive coding was used to identify core themes during the periods. Results Pre-FMT themes included physical (continuous diarrhea and weight loss), mental (depression, wanting to die, and fear), quality of life (unable to perform normal activities), social support, and financial (medication costs) factors. Provider resistance/limited awareness were barriers to FMT. Participants reached a tipping point, experiencing feelings of hopelessness, which led them to pursue FMT. During FMT, participants commented on lack of a so-called ick factor. During the posttreatment period, participants experienced symptom relief, but had residual fears. Patient activation was present during all phases, including information seeking and empowerment. Conclusions During the pre-FMT period, participants experienced extreme discomfort and encountered FMT barriers. Undergoing FMT was reported as easy but residual fear remained. There were displays of patient activation at all FMT time periods, including the seeking of FMT. Participants could have benefited from having undergone FMT sooner, demonstrating a need for improvement in provider education and health system barriers regarding FMT.
- Published
- 2016
25. A US View on Antimicrobial Stewardship in Animal Agriculture
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Amy L. Pakyz and Jennifer S. McDanel
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0301 basic medicine ,Cultural Studies ,Linguistics and Language ,History ,medicine.medical_specialty ,Veterinary medicine ,Animal food ,business.industry ,Public health ,030106 microbiology ,Animal agriculture ,Antimicrobial ,Language and Linguistics ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Anthropology ,Environmental health ,medicine ,Food processing ,Antimicrobial stewardship ,Livestock ,030212 general & internal medicine ,business - Abstract
Antimicrobial resistance was declared a serious threat to global public health by the World Health Organization. Actions have been taken to improve antimicrobial use, especially in settings such as hospitals. However, a large amount of antimicrobials are administered to food-producing animals, posing a risk of spread of antibiotic-resistant organisms to humans through contaminated retail meat, or by direct contact with animals. In the USA, efforts are in place to limit the use of antimicrobials for growth enhancement as opposed to disease prevention or treatment purposes. Additionally, the US Administration is calling for improved surveillance capabilities for the monitoring of antimicrobial use in livestock and for the tracking of antimicrobial resistance through the National Antimicrobial Resistance Monitoring System, as well as for development of antimicrobial alternatives for use in food production. The restaurant industry and meat suppliers are also committing to decreasing the amounts of antimicrobials used in animal food production.
- Published
- 2016
26. Pediatric Antimicrobial Stewardship: State of the Art
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Michael P. Stevens, Andrew J. Noda, John Daniel Markley, Emily Godbout, and Amy L. Pakyz
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medicine.medical_specialty ,business.industry ,Inpatient setting ,Antimicrobial ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Antibiotic resistance ,Key factors ,030225 pediatrics ,Health care ,medicine ,Antimicrobial stewardship ,Professional association ,030212 general & internal medicine ,Stewardship ,business ,Intensive care medicine - Abstract
We aim to systematically review the literature on the effectiveness of pediatric antimicrobial stewardship programs (ASPs) and antimicrobial stewardship (AS) strategies in the United States (US) inpatient setting. Furthermore, we review current gaps and challenges for unique pediatric populations and those in ambulatory settings. Misuse and overuse of antimicrobials have been identified as key factors for antimicrobial resistance (AR). Multiple professional organizations support the implementation of hospital-based ASPs to decrease antimicrobial consumption, improve patient outcomes, and reduce healthcare costs. There is limited data on the effectiveness of inpatient pediatric ASPs and AS strategies in unique populations. Furthermore, there is a paucity of evidence on ASPs in ambulatory settings. This review contributes to the growing body of evidence that supports the use of pediatric ASPs to optimize antimicrobial therapy in the inpatient setting as well as in unique patient populations and ambulatory settings. Active stewardship is critical and antimicrobial consumption is a key outcome metric for programs.
- Published
- 2018
27. Prevalence and Characteristics of Pediatric Opioid Exposures and Poisonings in the United States
- Author
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David C. Wheeler, S. Rutherfoord Rose, Anisha M. Patel, Pramit Nadpara, Norman V. Carroll, and Amy L. Pakyz
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Poison control ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Epidemiology ,Injury prevention ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,business.industry ,Infant ,Emergency department ,Opioid-Related Disorders ,United States ,Analgesics, Opioid ,Cross-Sectional Studies ,Opioid ,Socioeconomic Factors ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Buprenorphine ,medicine.drug ,Methadone - Abstract
To examine the prevalence and characteristics of pediatric opioid exposures and poisonings in the US.This was a retrospective, cross-sectional analysis using the National Poison Data System from January 1, 2010 to December 31, 2014. Records of children aged18 years with exposure to opioid-containing medications were identified. Standardized prevalence rates were calculated, and the annual trend was examined. Pediatric opioid exposures were characterized descriptively, and logistic regression was performed to estimate the association between various clinical and sociodemographic characteristics and exposures with serious (ie, moderate, major, or death) outcomes. The association of pediatric opioid exposures and area-level socioeconomic status factors at 5-digit ZIP code level was examined descriptively.The prevalence of opioid exposures was 22.6 per 100 000 children and was particularly high among ≤5-year-olds. Prevalence declined from 25.5 to 20 per 100 000 children from 2010 to 2014. There were 83 418 pediatric opioid exposures over the 5-year period and nearly one-half resulted in poisoning. Over 60% of exposures were among children ≤5 years of age, 73.4% were unintentional, and over 90% occurred at home. One in every 2 pediatric opioid exposures was evaluated in a healthcare facility. Annually 4912 children aged ≤5 years were treated in the emergency department or admitted for care. Older age, nonaccidental intent, and single-substance opioid, especially buprenorphine and methadone, were associated with serious outcomes (P .05). Positive correlations were observed for area-level socioeconomic status factors including proportion of adults and pediatric opioid exposures.Pediatric opioid exposures and poisonings decreased from 2010 to 2014 but morbidity remains high. The epidemiology of opioid exposures differed considerably by age.
- Published
- 2018
28. Performance of a Novel Antipseudomonal Antibiotic Consumption Metric Among Academic Medical Centers in the United States
- Author
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John Daniel Markley, Michael P. Stevens, Gonzalo Bearman, Samuel F. Hohmann, Amy L. Pakyz, and Roy T. Sabo
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,Carbapenem ,Epidemiology ,medicine.drug_class ,030106 microbiology ,Antibiotics ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Pseudomonas ,Medicine ,Humans ,Pseudomonas Infections ,030212 general & internal medicine ,Aged ,Consumption (economics) ,Aged, 80 and over ,Academic Medical Centers ,business.industry ,Censuses ,Patient mix ,Middle Aged ,Drug Utilization ,United States ,Anti-Bacterial Agents ,Infectious Diseases ,Cross-Sectional Studies ,Logistic Models ,Carbapenems ,Female ,Metric (unit) ,business ,medicine.drug - Abstract
A metric was developed to identify hospital proportion of carbapenem consumption (PoCC) among antipseudomonal antibiotics. The PoCC varied significantly among academic medical centers by Census Bureau geographic division after adjusting for patient mix. This metric may be useful in identifying disproportionate carbapenem use and potential carbapenem overuse.Infect Control Hosp Epidemiol 2018;39:229–232
- Published
- 2018
29. Rapid respiratory panel testing: Impact of active antimicrobial stewardship
- Author
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Michael P. Stevens, Shaina Bernard, Christopher D. Doern, Salma Abbas, Kimberly Lee, Michelle Doll, Gonzalo Bearman, and Amy L. Pakyz
- Subjects
medicine.medical_specialty ,Epidemiology ,business.industry ,Health Policy ,Virginia ,Public Health, Environmental and Occupational Health ,MEDLINE ,Polymerase Chain Reaction ,Drug Utilization ,Article ,Anti-Bacterial Agents ,Tertiary Care Centers ,Antimicrobial Stewardship ,Infectious Diseases ,Molecular Diagnostic Techniques ,medicine ,Humans ,Antimicrobial stewardship ,Respiratory system ,Intensive care medicine ,business ,Respiratory Tract Infections - Published
- 2019
30. 252. Relative Use of Carbapenems in Immunocompromised Patients
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Michael P. Stevens, Andrew Kirk, Jacob Pierce, Gonzalo Bearman, Kimberly Lee, John Daniel Markley, Amy L. Pakyz, Oveimar De La Cruz, and Michelle Doll
- Subjects
medicine.medical_specialty ,Carbapenem ,biology ,business.industry ,medicine.drug_class ,Cefepime ,Antibiotics ,Drug resistance ,Enterobacter ,Acinetobacter ,biology.organism_classification ,Meropenem ,Abstracts ,Infectious Diseases ,Oncology ,B. Poster Abstracts ,Internal medicine ,Piperacillin/tazobactam ,medicine ,business ,medicine.drug - Abstract
Background Gram-negative bacterial infections are associated with high mortality in immunocompromised hosts, and the presence of drug resistance further increases mortality. Antibiotic consumption is a key outcome measure for Antimicrobial Stewardship Programs. Proper utilization of antibiotics can help limit the development of antimicrobial resistance. Resistance in Gram-negative organisms such as Pseudomonas, Enterobacter, and Acinetobacter is a major issue given the paucity of new drugs in the antibiotic pipeline for these organisms. A novel relative carbapenem consumption metric (the Proportion of Carbapenem Consumption, or PoCC) was recently described in US academic medical centers. The PoCC is calculated as follows: PoCC = [(meropenem Days of therapy(DOT)/1,000 patient-days (PDs))/(meropenem DOT/1,000 PDs + cefepime DOT/1,000 PDs + piperacillin–tazobactam DOT/1,000 PDs)]. The regional mean PoCC for the South Atlantic region has previously been approximated at 17%. Methods We examined the PoCC for the Bone Marrow Transplant (BMT) and dedicated Hematology/Oncology (H/O) inpatient wards at an academic medical center from August 2012 to June 2017. Results Table 1: Average Use of Antibiotics Expressed in DOT/1,000 PDs. Ward Piperacillin– Tazobactam Cefepime Meropenem Total PoCC Hematology/oncology 105.1 134.4 76.6 316.1 0.24 Bone marrow transplant 34.3 201.0 127.4 362.7 0.35 National meansa 76.2 60.2 30.7 b 0.18 aAs described by Markley et al. Infect Control Hosp Epidemiol 2018;39:229–232. bData unavailable. Conclusion This is the first description of the PoCC metric for dedicated Hematology/Oncology and Bone Marrow Transplant wards. When compared with national and regional mean PoCC scores for academic medical centers, the PoCC for these units was higher. More research is needed to determine the optimal PoCC scores for these types of units. The PoCC can contextualize relative carbapenem use and may be a useful antibiotic consumption metric. However, it does not provide data on absolute consumption. Further studies are needed to determine the best use of the PoCC metric by Antimicrobial Stewardship Programs for Hematology/Oncology and Bone Marrow Transplant wards. Disclosures All authors: No reported disclosures.
- Published
- 2018
31. 1873. Next Steps in Predicting Anti-MRSA Antibiotic Prescribing
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Samuel F. Hohmann, Gregory B Tallman, Rochelle Fu, Amy L. Pakyz, Haley K Holmer, Jessina C. McGregor, Miriam R. Elman, and Kristi Kuper
- Subjects
medicine.medical_specialty ,Abstracts ,Infectious Diseases ,Oncology ,B. Poster Abstracts ,business.industry ,medicine ,Anti mrsa ,Intensive care medicine ,business ,Antibiotic prescribing - Abstract
Background Antibiotic use metrics are utilized by antimicrobial stewardship programs to benchmark performance against peer institutions and inform stewardship efforts. Benchmarking requires risk adjustment for patient- and facility-level factors so that remaining differences are attributable only to prescribing practices. Antibiotics for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) are one of the most frequently used drug classes. Our objective was to identify predictors of anti-MRSA antibiotic use in a nationwide network of hospitals. Methods We used data from inpatient encounters at facilities participating in the Vizient data repository between January 1, 2016 and December 31, 2016. The outcome, anti-MRSA antibiotic use, was calculated as days of therapy per patient-days present for each encounter. We constructed a multivariable negative binomial regression model and assessed the following predictors for inclusion: age, sex, race, ethnicity, diagnosis related groups (DRGs), ICU days, admit month, facility bed size, facility teaching status, and region. A clinical framework was used to categorize DRGs based on risk of anti-MRSA antibiotic use. A backwards stepwise approach was used to identify the final model. We evaluated predictor effect size and significance, and assessed model fit using a deviance-based pseudo-R2. Results One hundred forty-five facilities representing 3,608,711 encounters met inclusion criteria. All predictors considered in our model were significant. Predictors with the greatest magnitude of association included DRG categories and patient age. The DRG categories with the strongest associations were DRGs for infections likely due to Staphylococcus aureus (RR = 1.66, P < 0.0001) or for diagnoses likely to receive long-term MRSA coverage (RR = 1.49, P < 0.0001). The age group with the strongest association was age 2–10 years (RR = 1.64; P < 0.001). The deviance-based pseudo-R2 of the final model was 0.19, indicating good model fit. Conclusion DRGs and patient-level characteristics can be utilized to account for variability in anti-MRSA antibiotic use beyond what is explained through facility-level characteristics. Incorporation of the significant predictors identified in this study may aid in more meaningful interhospital comparisons of anti-MRSA antibiotic use in both adults and pediatrics. Disclosures J. C. McGregor, Merck: Grant Investigator, Research grant.
- Published
- 2018
32. An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage
- Author
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Michael B. Edmond, Michael P. Stevens, Hui Wang, Amy L. Pakyz, and Leticia R. Moczygemba
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Pharmacology ,Microbiology (medical) ,Academic Medical Centers ,medicine.medical_specialty ,Composite score ,business.industry ,Health Policy ,Audit ,Antimicrobial ,Drug Utilization ,Anti-Bacterial Agents ,Infectious Diseases ,Antimicrobial use ,Dose optimization ,Negatively associated ,Internal medicine ,medicine ,Humans ,Antimicrobial stewardship ,Pharmacology (medical) ,business ,Intensive care medicine ,Delivery of Health Care ,Oral therapy ,Original Research - Abstract
Objectives To determine whether an antimicrobial stewardship ‘intensity’ score predicts hospital antimicrobial usage. Methods An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy programmes, de-escalation of therapy, antimicrobial order forms and dose optimization). Multiple regression analyses were used to assess whether the composite score and also the categories were associated with either total or antimicrobial stewardship programme-target antimicrobial use as measured in days of therapy. Results The mean antimicrobial stewardship programme score was 55 (SD 21); the total composite score was not significantly associated with total or target antimicrobial use [estimate –0.49 (95% CI –2.30 to 0.89)], while the category strategies was significantly and negatively associated with target antimicrobial use [–5.91 (95% CI –9.51 to –2.31)]. Conclusions The strategy component of a score developed to measure the intensity of antimicrobial stewardship was associated with the amount of antimicrobials used. Thus, the number and types of strategies employed by antimicrobial stewardship programmes may be of particular importance in programme effectiveness.
- Published
- 2015
33. Treatment of Vancomycin-Resistant Enterococci: Focus on Daptomycin
- Author
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Rose M. Kohinke and Amy L. Pakyz
- Subjects
0301 basic medicine ,Drug ,medicine.medical_specialty ,media_common.quotation_subject ,030106 microbiology ,Serious infection ,03 medical and health sciences ,Minimum inhibitory concentration ,0302 clinical medicine ,Internal medicine ,medicine ,High doses ,030212 general & internal medicine ,Adverse effect ,media_common ,biology ,business.industry ,Vancomycin-Resistant Enterococci ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Infectious Diseases ,lipids (amino acids, peptides, and proteins) ,Daptomycin ,business ,Enterococcus faecium ,medicine.drug - Abstract
Vancomycin-resistant Enterococci (VRE) infections are problematic due to limited availability of anti-VRE agents and their potential for adverse effects and drug interactions. This review focuses on the role of daptomycin in treating VRE infections by summarizing key points of relevant clinical studies. Higher doses of daptomycin (≥ 6 mg/kg), as compared to standard doses, were found to be safe in terms of creatinine phosphokinase elevation and associated with successful infection outcomes and microbiological clearance. High doses are especially important in treatment of infections involving elevated daptomycin minimum inhibitory concentration (MIC) values (3–4 μg/mL). Daptomycin, especially in higher doses, has been shown to be an effective and safe VRE agent for a variety of serious infection types, such as catheter-associated bloodstream and intra-abdominal infections, and for different populations including oncology. Infections involving higher daptomycin MIC values were associated with previous daptomycin use and prosthetic devices.
- Published
- 2017
34. Description of a restriction program for gram-positive antimicrobial agents at an academic medical center
- Author
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Michael P. Stevens, Michelle Doll, Gonzalo Bearman, Perry Taylor, Amy L. Pakyz, Andrew Kirk, Kakotan Sanogo, Anita Molayi, Shaina Bernard, Kimberly Lee, and John Daniel Markley
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Time Factors ,Epidemiology ,medicine.drug_class ,030106 microbiology ,Antibiotics ,Inappropriate Prescribing ,Tertiary care ,03 medical and health sciences ,Antimicrobial Stewardship ,0302 clinical medicine ,Antibiotic resistance ,Health care ,medicine ,Antimicrobial stewardship ,Humans ,030212 general & internal medicine ,Antibiotic use ,Intensive care medicine ,Gram-Positive Bacterial Infections ,Gram ,Academic Medical Centers ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Antimicrobial ,Drug Utilization ,Anti-Bacterial Agents ,Infectious Diseases ,business ,Hospital Units - Abstract
This report examines the effectiveness of antimicrobial restriction at 1 tertiary care health care system by analyzing the consumption of restricted versus nonrestricted gram-positive agents over time for medical versus surgical units. Significant reductions in restricted antibiotic use were detected in 57% of medical units versus none of the surgical units. There were no significant reductions in nonrestricted antibiotic use. We think looking at antibiotic consumption by service line provides opportunities for targeted antibiotic restriction program refinement.
- Published
- 2017
35. Identifying hospital antimicrobial resistance targets via robust ranking
- Author
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Amy L. Pakyz, Ron E. Polk, J. Paul Brooks, and José H. Dulá
- Subjects
Protocol (science) ,business.industry ,Public Health, Environmental and Occupational Health ,020206 networking & telecommunications ,0102 computer and information sciences ,02 engineering and technology ,computer.software_genre ,01 natural sciences ,Article ,Antibiotic resistance ,Ranking ,010201 computation theory & mathematics ,Outlier ,Statistics ,0202 electrical engineering, electronic engineering, information engineering ,Medicine ,Data mining ,Safety, Risk, Reliability and Quality ,business ,Safety Research ,computer ,Management practices - Abstract
We develop a robust ranking procedure to uncover trends in variation in antibiotic resistance (AR) rates across hospitals for some antibiotic-bacterium pairs over several years. We illustrate how the method can be used to detect potentially dangerous trends and to direct attention to hospitals' management practices. A robust method is indicated due to the fact that some unusual reported resistance rates may be due to measurement protocol differences and not any real difference in AR rates. Our proposed method is less sensitive to outlier observations than other robust methods. The application on real AR data shows how a dangerous trend in a particular AR rate would be detected. Our results indicate the potential benefits of systematic AR rate collection and AR reporting systems across hospitals.
- Published
- 2017
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36. Medication risk factors associated with healthcare-associated Clostridium difficile infection: a multilevel model case-control study among 64 US academic medical centres
- Author
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Spencer E. Harpe, Amy L. Pakyz, Rachel Jawahar, and Qin Wang
- Subjects
Adult ,Diarrhea ,Male ,Microbiology (medical) ,Carbapenem ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Cephalosporin ,Logistic regression ,Odds ,Young Adult ,Risk Factors ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Intensive care medicine ,Aged ,Aged, 80 and over ,Pharmacology ,Academic Medical Centers ,Cross Infection ,Clostridioides difficile ,business.industry ,Case-control study ,Clindamycin ,Middle Aged ,Clostridium difficile ,United States ,Anti-Bacterial Agents ,Infectious Diseases ,Case-Control Studies ,Clostridium Infections ,Vancomycin ,Female ,business ,medicine.drug - Abstract
Objectives The main objective of this study was to determine patient- and hospital-level medication risk factors associated with Clostridium difficile infection (CDI) occurrence among patients clustered within hospitals using a multilevel model. Methods Patients with healthcare-associated (HA)-CDI were identified from among 64 academic medical centres in 2009. A frequency match was conducted; for each case, up to two controls were selected, matched on similar pre-infection length of stay and clinical service line. Patient- and hospital-level medication use, including antibacterial and gastric acid-suppressant agents, was assessed using a two-level logistic regression model. Results A total of 5967 CDI cases and 8167 controls were included in the analysis. The odds of acquiring HA-CDI increased with the following medications [OR (95% CI)]: anti-methicillin-resistant Staphylococcus aureus agents [1.38 (1.22-1.56)]; third- or fourth-generation cephalosporins [1.75 (1.62-1.89)]; carbapenems [1.60 (1.44-1.79)]; β-lactam/β-lactamase inhibitor combinations [1.49 (1.36-1.64)]; vancomycin [1.73 (1.57-1.89)]; and proton pump inhibitors [1.43 (1.30-1.57)]. The odds of acquiring HA-CDI decreased with the following medications: clindamycin [0.74 (0.63-0.87)]; and macrolides [0.88 (0.77-0.99)]. Controlling for patient-level covariates, no hospital-level medication covariates that we analysed had statistically significant effects on HA-CDI. The odds of acquiring HA-CDI increased with the hospital proportion of patients aged ≥ 65 years [1.01 (1.00-1.02)]. Conclusions We found several medications that were associated with the risk of patients developing HA-CDI, including β-lactam/β-lactamase inhibitor combinations, third- or fourth-generation cephalosporins, carbapenems, vancomycin, proton pump inhibitors and anti-methicillin-resistant S. aureus agents. There were no medication effects significant at the hospital level.
- Published
- 2013
37. Challenges in Measuring Antibiotic Consumption
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Amy L. Pakyz and Leigh Anne Hylton Gravatt
- Subjects
Consumption (economics) ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,Antibiotics ,Adult population ,MEDLINE ,Pharmacy ,Infectious Diseases ,Defined daily dose ,Antibacterial resistance ,medicine ,Antimicrobial stewardship ,Intensive care medicine ,business - Abstract
The measurement of antibacterial consumption is important for tracking use over time, for assessing correlations between use and antibacterial resistance, and for serving as an outcome measure for antimicrobial stewardship programs. Accurate and consistent measures of use are important for meaningful inter- and intrainstitutional comparisons. The defined daily dose (DDD) and days of therapy methods are commonly used measures in the adult population; however, there is no one ideal measure of consumption that covers the breadth and depth of antibacterial prescribing. The use of the DDD and the prescribed daily dose methods, with further stratification of use by weight and age groups, aids in the evaluation of antimicrobial use in pediatric patients. Increasing availability of computerized pharmacy data should enhance the collection and analysis of data from hospitals.
- Published
- 2013
38. 232. Do Antibiotic Timeouts Improve Antibiotic Utilization?
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Amanda Gibson, Amy L. Pakyz, Michael Postelnick, Patrick Kinn, Lucas T Schulz, and Kristi Kuper
- Subjects
medicine.medical_specialty ,Abstracts ,Infectious Diseases ,Oncology ,B. Poster Abstracts ,medicine.drug_class ,business.industry ,Antibiotics ,medicine ,Intensive care medicine ,business - Abstract
Background The antibiotic timeout (ATO) is a stewardship tool that protocolizes review of objective clinical data after a predefined period of time and encourages antimicrobial regimen re-assessment. Methods Vizient member hospitals were utilized to recruit a variety of acute healthcare institutions, including institutions with and without an ATO process. Participating institutions submitted de-identified patient-level antibiotic therapy courses from a single day within a 5-week window to create a snapshot of overall antibiotic utilization. Therapy courses were evaluated on metrics including the prevalence of anti-pseudomonal agents, agents active against methicillin-resistant Staphylococcus aureus (MRSA), and oral (vs. intravenous) antibiotics. The outcome measures included: percent changes in prevalence of courses with antipseudomonal and anti-MRSA agents after day 3, and percent change in antibiotics ordered for oral administration after day 3. These outcome measures were compared between ATO institutions and non-ATO institutions. Results A total of 6,184 antibiotic therapy courses were collected from 61 participating institutions (17 ATO institutions; 44 non-ATO institutions). Of 71 institutions that completed enrollment survey, 10 did not complete submission of therapy course data. Antibiotic courses prescribed for prophylaxis (n = 975) and courses that extended beyond 7 days (n = 1,192) were excluded from analysis, resulting in an analysis group that included 4,017 therapy courses (1,396 from ATO institutions vs. 2,621 from non-ATO institutions). The prevalence of patients receiving anti-pseudomonal agents increased after day 3 by 3.03% (P = 0.28) at ATO institutions and decreased 0.45% (P = 0.84) at non-ATO institutions. The prevalence of patients receiving anti-MRSA agents decreased after day 3 by 2.16% (P = 0.41) at ATO institutions and decreased 5.05% (P = 0.005) at non-ATO institutions. Oral antibiotic use increased after day 3 by 3.09% (P = 0.08) at ATO institutions while use at non-ATO institutions increased 7.99% (P = 0.0001). Conclusion Antibiotic therapy course data collected across multiple sites provided no evidence for improved antimicrobial utilization among institutions that have implemented an antibiotic timeout compared with institutions without a timeout. Disclosures All authors: No reported disclosures.
- Published
- 2018
39. 242. Evaluating the Effectiveness of Antimicrobial Restriction at an Academic Medical Center
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John Daniel Markley, Kimberly Lee, Gonzalo Bearman, Michael P. Stevens, Andrew Kirk, Michelle Doll, and Amy L. Pakyz
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Abstracts ,medicine.medical_specialty ,Infectious Diseases ,B. Poster Abstracts ,Oncology ,business.industry ,Medicine ,Medical physics ,Center (algebra and category theory) ,business ,Antimicrobial - Abstract
Background Antimicrobial Stewardship Programs (ASPs) promote the optimal use of antimicrobial agents with the goal of preserving the effectiveness of existing drugs. One core ASP strategy is formulary restriction and preauthorization (PA). We evaluated restricted antimicrobial use at an academic medical center in Virginia; our program has a comprehensive restriction program that applies to adults only. Methods Data from August 2012 to June 2017 were evaluated at the hospital unit level by month in days of therapy (DOT) per 1,000 patient-days. Ordinary least squares regression was used to compare the time trend of restricted use with that of nonrestricted agents within the same unit. Results Across the study period significant decreases in restricted antibiotic use were detected for medical and pediatric units with no significant increases in use. However, significant increases were identified for surgical units. Table 1: Results of Time Trend Analysis by Unit for Restricted Drugs. Restricted Type Unit Time Trend P Medical Oncology 0.64 0.0924 Acute Care Medicine 0.39 0.4058 Cardiac ICU −0.37 0.1057 Medical ICU −2.06 0.0002 Bone Marrow Transplant 0.52 0.5002 Digestive Health −0.14 0.3004 Progressive Care −0.93 0.0002 Pediatric General Pediatrics −0.36 0.1363 Neonatal ICU −0.29 0.0007 Pediatric ICU −0.12 0.7849 Progressive Care −0.29 0.0993 Surgical Acute Care Surgery −0.30 0.1574 Burn ICU 0.84 0.0021 Cardiac Surgery ICU −0.50 0.2766 Surgical Trauma ICU −0.52 0.1019 Table 2: Significant Increases/ Decreases in Restricted Antimicrobials by Unit Type Restricted Unit Type Increase Decrease Medical 0/7 (0%) 2/7 (29%) Pediatric 0/4 (0%) 1/4 (25%) Surgical 1/4 (25%) 0/4 (0%) Conclusion These data suggest that the PA strategy for medical wards was effective across the time period whereas the PA strategy for surgical wards was suboptimal. However, it is unclear why pediatric wards (that were not subject to PA activities) also saw reductions in use; more research into this is needed. These data will help us to refine our PA strategy by targeting use on surgical wards. We believe that this type of analysis may be useful for other ASPs utilizing the PA strategy. Disclosures All authors: No reported disclosures.
- Published
- 2018
40. 1879. A Point Prevalence Study of Antibiotic Utilization in 61 Geographically Diverse Acute Care Hospitals (2017)
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Lucas T Schulz, Amanda Gibson, Kristi Kuper, Amy L. Pakyz, Michael Postelnick, and Patrick Kinn
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Abstracts ,medicine.medical_specialty ,Infectious Diseases ,B. Poster Abstracts ,Oncology ,business.industry ,medicine.drug_class ,Family medicine ,Acute care ,Antibiotics ,Prevalence ,Medicine ,business - Abstract
Background Antibiotic utilization for geographically diverse areas can be difficult to obtain. The purpose of this study was to characterize patterns of US antibiotic use over a defined period to provide comparative data for benchmarking and to assist with identifying antibiotic stewardship opportunities. Methods Data were obtained as part of a larger study evaluating antibiotic time out practices. Participating institutions submitted de-identified patient-level antibiotic use data from a single day (between October 16, 2017 and November 17, 2017). Indication, expected duration, and antibiotic stop dates were documented. Antibiotics were classified by American Hospital Formulary Service (AHFS) therapeutic category and evaluated to identify duplicate anti-anaerobic, anti-MRSA, and AHFS classes. Hospital teaching status and US Census region were recorded. Results A total of 6,184 courses of therapy (8,996 individual antibiotics) were evaluated from 61 hospitals. Sixty-four percent of therapy courses submitted were from academic medical centers. Distribution by census region was Midwest (44.7%), Northeast (15.11%), South (23.2%), and West (16.9%). Over half (53.7%) of therapy was empiric and 33.4% was directed. Sixty-six percent of courses did not include a stop date within the electronic medical record. Twelve drugs comprised 80% of total antibiotic use. Percentage of antipseudomonal use was similar across regions, but anti-MRSA therapy was higher in the South and Midwest. Duplicate β-lactam therapy and duplicate anti-anaerobe therapy were identified in 1.5% of total courses (each). Duplicate anti-MRSA therapy occurred in 0.29% of therapy courses. Three percent of patients developed a Clostridium difficile infection during their hospitalization. Conclusion Vancomycin and piperacillin–tazobactam were the most common antibiotics used which is consistent with other analyses, but anti-anaerobic use as a percentage of overall use was higher than expected. Duplicate anti-anaerobe and β-lactam therapy is less frequent, but still represents an opportunity for stewardship. Antipseudomonal and anti-MRSA agents represent two key categories for stewardship given the high percentage of use. The addition of a stop date to the antibiotic order presents an opportunity to improve overall utilization. Disclosures All authors: No reported disclosures.
- Published
- 2018
41. Performance of the Present-on-Admission Indicator for Clostridium difficile Infection
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Kate L. Lapane, Amy L. Pakyz, Samuel F. Hohmann, Christine Motzkus-Feagans, Julie A. Patterson, and Michael B. Edmond
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Microbiology (medical) ,medicine.medical_specialty ,Databases, Factual ,Epidemiology ,MEDLINE ,Present on admission ,Sensitivity and Specificity ,Patient Admission ,International Classification of Diseases ,Predictive Value of Tests ,Internal medicine ,Electronic Health Records ,Humans ,Medicine ,Enterocolitis, Pseudomembranous ,Quality Indicators, Health Care ,Enterocolitis ,Cross Infection ,Clostridioides difficile ,business.industry ,Clostridium difficile ,Community-Acquired Infections ,Infectious Diseases ,Predictive value of tests ,medicine.symptom ,business - Abstract
The performance of a hospital- and community-onset Clostridium difficile infection definition using administrative data with a present-on-admission indicator was compared with definitions using clinical surveillance. For hospital-onset C. difficile infection, there was moderate sensitivity (68%) and high specificity (93%); for community-onset, sensitivity and specificity were high (both 85%).Infect Control Hosp Epidemiol 2015;36(7):838–840
- Published
- 2015
42. Use of Data Envelopment Analysis to Quantify Opportunities for Antibacterial Targets for Reduction of Health Care–Associated Clostridium difficile Infection
- Author
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Yasar A. Ozcan and Amy L. Pakyz
- Subjects
medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,Health care associated ,Claims data ,Data envelopment analysis ,Humans ,Medicine ,Practice Patterns, Physicians' ,Intensive care medicine ,Enterocolitis, Pseudomembranous ,Retrospective Studies ,Cross Infection ,Clostridioides difficile ,business.industry ,Health Policy ,Clindamycin ,Percentage reduction ,Clostridium difficile ,C difficile ,Anti-Bacterial Agents ,Benchmarking ,Cross-Sectional Studies ,Practice Guidelines as Topic ,Emergency medicine ,Guideline Adherence ,business ,medicine.drug - Abstract
Clostridium difficile infection (CDI) is an important health care-associated infection that leads to increased morbidity and mortality. Antibacterial medications used in hospitals serve as targets for antibacterial stewardship programs to reduce C difficile. The objective was to create a benchmark strategy targeting high-risk antibacterials for C difficile. This was a retrospective cross-sectional study using claims data from 58 hospitals. The Data Envelopment Analysis Technique was used to identify best-practice hospitals in terms of less use of 5 classes of antibacterials and fewer CDIs. Of 58 hospitals, 17 (29%) were identified as best-practice hospitals. Antibacterial classes requiring the greatest percentage reduction in use in non-best-practice hospitals versus best-practice hospitals were clindamycin (31%), β-lactam/β-lactamase combinations (30%), and carbapenems (29%). This study suggests that there are areas of improvement in high-risk antibacterial use that could lead to decreased CDIs.
- Published
- 2013
43. Influence of State Laws Mandating Reporting of Healthcare-Associated Infections: The Case of Central Line–Associated Bloodstream Infections
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Michael B. Edmond and Amy L. Pakyz
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Microbiology (medical) ,Healthcare associated infections ,Epidemiology ,Cross-sectional study ,media_common.quotation_subject ,Bacteremia ,Ordered probit ,Legislation ,Data submission ,State (polity) ,Bloodstream infection ,Central Venous Catheters ,Humans ,Medicine ,Retrospective Studies ,media_common ,Academic Medical Centers ,Cross Infection ,Central line ,business.industry ,Mandatory Reporting ,Hospitals ,United States ,Cross-Sectional Studies ,Infectious Diseases ,Catheter-Related Infections ,Law ,Legislation, Hospital ,business - Abstract
Objective.To evaluate the impact of state laws on reporting of healthcare-associated infections on central line-associated bloodstream infection (CLABSI) rates.Design.Retrospective, cross-sectional study.Methods.Hospital-level administrative and Hospital Compare data were collected on University HealthSystem Consortium hospitals. An ordered probit regression model assessed the association between state legislation and CLABSI standardized infection ratio (SIR). The main independent variable was a state legislation variable concerning 3 legal requirements (data submission, reporting of data to the public, inclusion of facility identifiers in public reports) and was coded for hospitals accordingly located in a state that did not have CLABSI reporting, located in a state that had CLABSI reporting legislation and met 3 legal requirements, or located in a state that had CLABSI reporting but did not meet the 3 legal requirements. A secondary analysis ascertained whether the mean state SIR values differed among the 3 legislation groups.Results.There were 159 hospitals included; 92 were located in states that had CLABSI reporting and met 3 requirements, 33 were located in states that had reporting but did not meet the 3 requirements, and 34 were in states that had no legislation. There was no effect of state legislation group on CLABSI SIR. There were no significant differences in the mean state CLABSI SIRs among the legislation groups.Conclusions.In this sample of academic medical centers, there was no evidence of an effect of state HAI laws on CLABSI occurrence. The impact of state legislation may be lessened by other CLABSI prevention initiatives.
- Published
- 2013
44. Statin use and infections in Veterans with cirrhosis
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Kate L. Lapane, Amy L. Pakyz, Christine Motzkus-Feagans, J. S. Bajaj, and Scott M. Ratliff
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Statin ,Hospitals, Veterans ,medicine.drug_class ,Anti-Infective Agents ,Quality of life ,Recurrence ,Risk Factors ,Metronidazole ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Decompensation ,Enterocolitis, Pseudomembranous ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,Clostridioides difficile ,Proportional hazards model ,business.industry ,Hazard ratio ,Gastroenterology ,Middle Aged ,medicine.disease ,United States ,Confidence interval ,Surgery ,Military Personnel ,Treatment Outcome ,Cohort ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business - Abstract
Summary Background Evidence about the beneficial effects of statins on reducing infections is accumulating. Identifying ways to reduce infection risk in patients with cirrhosis is important because of increased mortality risk and costs associated with infections. Aim To estimate the extent to which statin use prolongs time to infection among patients with cirrhosis. Methods We identified Veterans with cirrhosis, but without decompensation (n = 19 379) using US Veterans Health Administration data from 2001 to 2009. New users of statins were identified and propensity matched to non-users and users of other cholesterol-lowering medications (1:1 matching). The cohort was followed up for hospitalisations with infections. Cox regression models with time-varying exposures provided estimates of adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results New statin use was present among 13% of VA patients with cirrhosis without decompensation. Overall, 12.4% of patients developed a serious infection, and 0.1% of patients died. In the propensity-matched sample, statin users experienced hospitalisations with infections at a rate 0.67 less than non-users (95% Confidence Interval: 0.47–0.95). Conclusions Infections are a major concern among cirrhotic patients and have the potential to seriously impact both life expectancy and quality of life. Statin use may potentially reduce the risk of infections among patients with cirrhosis.
- Published
- 2013
45. Association Between High-Risk Medication Usage and Healthcare Facility-Onset C. difficile Infection
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Amy L. Pakyz, Michael B. Edmond, Samuel F. Hohmann, and Julie A. Patterson
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Microbiology (medical) ,Male ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,Risk medication ,Epidemiology ,030501 epidemiology ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Antimicrobial stewardship ,Humans ,030212 general & internal medicine ,Hospital patients ,Practice Patterns, Physicians' ,Cross Infection ,business.industry ,Significant difference ,C difficile ,United States ,Anti-Bacterial Agents ,Infectious Diseases ,Antimicrobial use ,Cross-Sectional Studies ,Clostridium Infections ,Female ,Health Services Research ,0305 other medical science ,business - Abstract
OBJECTIVENational hospital performance measures for C. difficile infection (CD) are available; comparing antibacterial use among performance levels can aid in identifying effective antimicrobial stewardship strategies to reduce CDI rates.DESIGNHospital-level, cross-sectional analysis.METHODSHospital characteristics (ie, demographics, medications, patient mix) were obtained for 77 hospitals for 2013. Hospitals were assigned 1 of 3 levels of a CDI standardized infection ratio (SIR): ‘Worse than,’ ‘Better than,’ or ‘No different than’ a national benchmark. Analyses compared medication use (total and broad-spectrum antibacterials) for 3 metrics: days of therapy per 1,000 patient days; length of therapy; and proportion of patients receiving a medication across SIR levels. A multivariate, ordered-probit regression identified characteristics associated with SIR categories.RESULTSRegarding total average antimicrobial use per patient, there was a significant difference detected in mean length of therapy: ‘No different’ hospitals having the longest (4.93 days) versus ‘Worse’ (4.78 days) and ‘Better’ (4.43 days) (PPPPCONCLUSIONSThese findings have potential implications regarding the need to fully account for hospital patient mix when carrying out inter-hospital comparisons of CDI rates.Infect Control Hosp Epidemiol 2016;37:909–915
- Published
- 2016
46. Associations Between Antimicrobial Stewardship Program Elements and Clostridium difficile Infection Performance
- Author
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Jeremy S. Stultz, Amy L. Pakyz, Julie A. Patterson, and Giulia Barlow
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0301 basic medicine ,medicine.medical_specialty ,Epidemiology ,030106 microbiology ,030501 epidemiology ,Microbiology ,Antimicrobial Stewardship ,03 medical and health sciences ,Humans ,Medicine ,Antimicrobial stewardship ,National level ,Intensive care medicine ,Retrospective Studies ,Clostridioides difficile ,Prospective audit ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Clostridium difficile ,C difficile ,Hospitals ,Anti-Bacterial Agents ,Audit and feedback ,Infectious Diseases ,Oncology ,Clostridium Infections ,0305 other medical science ,business - Abstract
Hospitals are categorized as better, no different, or worse at a national level based on their Clostridium difficile infection performance. Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown. We found that a higher proportion of hospitals with either a worse or no different rank used a postprescription audit and feedback strategy than hospitals with a better rank.
- Published
- 2016
47. Development of Institution-Specific Sepsis Guidelines for Double Coverage of Gram-Negative Infections
- Author
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Shaina Bernard, Michael P. Stevens, DaleMarie Vaughan, and Amy L. Pakyz
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Sepsis ,medicine.medical_specialty ,Pediatrics ,Infectious Diseases ,Oncology ,business.industry ,Medicine ,business ,medicine.disease ,Intensive care medicine ,Gram - Published
- 2016
48. How Ready Are Hospitals to Meet The Centers for Medicare and Medicaid Antibiotic Stewardship Requirements?
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Michael P. Stevens, Kristi Kuper, Amy L. Pakyz, Shaina Bernard, and Natalie Nguyen
- Subjects
0301 basic medicine ,Gerontology ,medicine.medical_specialty ,business.industry ,030106 microbiology ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Oncology ,Family medicine ,medicine ,Antibiotic Stewardship ,030212 general & internal medicine ,business ,Medicaid - Published
- 2016
49. Characterization of Continued Antibacterial Therapy After Diagnosis of Hospital-Onset Clostridium difficile Infection: Implications for Antimicrobial Stewardship
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Amy L. Pakyz, Spencer E. Harpe, Timothy J. Inocencio, Ron E. Polk, and Michael Oinonen
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,genetic structures ,Administration, Oral ,Patient Readmission ,Severity of Illness Index ,Cohort Studies ,Vancomycin ,Severity of illness ,medicine ,Humans ,Antimicrobial stewardship ,Pharmacology (medical) ,Aged ,Retrospective Studies ,Antibacterial agent ,Academic Medical Centers ,Cross Infection ,Clostridioides difficile ,business.industry ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Pharmacoepidemiology ,Clostridium difficile ,Hospitals ,United States ,Anti-Bacterial Agents ,Metronidazole ,Treatment Outcome ,Concomitant ,Clostridium Infections ,Female ,business ,medicine.drug - Abstract
Study Objectives To determine the proportion of hospitalized adults with hospital-onset Clostridium difficile infection (CDI) who continued to receive concomitant non-CDI antibacterial agents, to characterize the antibacterial therapy that these patients received before and after the diagnosis of CDI, and to compare hospital outcomes between those patients who did and those who did not have their previous antibacterial therapy discontinued after CDI diagnosis. Design Retrospective cohort study. Data Source Drug use and administrative discharge data from 42 United States academic medical centers. Patients A total of 5968 adult inpatients with hospital-onset CDI between January 1, 2002, and June 30, 2006. Measurements and Main Results We characterized patient-level antibacterial agent use before and after CDI diagnosis. Overall, 3479 patients (58.3%) continued antibacterial therapy for 2 or more days after CDI diagnosis (interhospital range 6.7–72.2%). Although the number of different antibacterial agents received in the week preceding CDI diagnosis was positively associated with continued antibacterial therapy, the relationship between continuation and severity of illness was statistically significant but nonlinear. Patients who were receiving oral vancomycin alone were less likely to have antibacterial therapy continued (28/61 patients [45.9%]) than patients receiving metronidazole alone (1154/2333 patients [49.5%]) or receiving both metronidazole and oral vancomycin (2297/3576 [64.2%]). After adjusting for confounders, patients who continued to receive antibacterial therapy had a 62.7% (95% confidence interval [CI] 48.6–78.0%, p
- Published
- 2012
50. Antifungal use in hospitalized adults in U.S. academic health centers
- Author
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Amy L. Pakyz, Michael Oinonen, and Holly E. Gurgle
- Subjects
Adult ,Azoles ,Antifungal ,medicine.medical_specialty ,Bone marrow transplant ,Antifungal Agents ,medicine.drug_class ,Cephalosporin ,Echinocandins ,Lipopeptides ,chemistry.chemical_compound ,Caspofungin ,Internal medicine ,Claims data ,Humans ,Medicine ,Practice Patterns, Physicians' ,Intensive care medicine ,Pharmacology ,Voriconazole ,Academic Medical Centers ,business.industry ,Health Policy ,Triazoles ,United States ,Pyrimidines ,chemistry ,Multivariate Analysis ,Regression Analysis ,business ,medicine.drug - Abstract
Purpose Use of antifungal agents and predictors of total antifungal use among adult inpatients at U.S. academic health centers was characterized. Methods Claims data obtained from a geographically representative sample of U.S. nonprofit academic health centers were analyzed to characterize use of systemic antifungals during the period 2004–08. Aggregate data were analyzed to identify trends in use of three antifungal classes (azoles, polyenes, echinocandins), as well as individual antifungal agents. Multivariate regression analysis was employed to investigate predictors of total antifungal use and interhospital variability in antifungal use. Results Aggregate antifungal use at health centers included in the data analysis increased from (mean ± S.D.) 82 ± 36 days of therapy (DOT) per 1000 patient-days in 2004 to 88 ± 39 DOT per 1000 patient-days in 2007 and then declined to 77 ± 36 DOT per 1000 patient-days in 2008. Use of voriconazole increased significantly during the study period ( p < 0.0001), while use of caspofungin decreased significantly ( p < 0.0001). Higher use of third- or fourth- generation cephalosporins was a significant predictor of higher total antifungal use ( p = 0.0005); performance of more stem cell or bone marrow transplants was also significantly associated with greater antifungal use. Conclusion Total antifungal use at a sample of U.S. academic health centers increased from 2004 to 2007 but decreased to below baseline in 2008. Azoles were the most commonly used agents. In 2008, total antifungal use at the centers ranged from 29 to 334 DOT per 1000 patient-days.
- Published
- 2011
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