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Inflammatory back pain is a hallmark feature of axial spondyloarthritis, a heterogeneous group of inflammatory disorders which affects the sacroiliac joints and spine. Imaging plays a key role in diagnosis of this disease and in facilitating appropriate treatment. This document provides evidence-based recommendations on the appropriate use of imaging studies during multiple stages of the clinical evaluation of patients with suspected or known axial spondyloarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) associated infections are a cause of morbidity/mortality in the Intensive Care Unit (ICU). Vancomycin is an option for treatment but is not without its own risks.PurposeTo institute a testing change to decrease time between ordering of MRSA tests and availability of results in patients admitted to the adult ICU.ProceduresA MRSA testing change was implemented at two adult (i.e., tertiary and community) ICUs located in a U.S. Midwestern health system. The change was implemented in 2018 and included the switch from culture to polymerase chain reaction (PCR) in ICU admitted patients. Study data were collected from 2016-2020 and a Bayesian quantile regression model was fit to examine median level change in time to results and to calculate a counterfactual estimate.Main FindingsDuring the 58-month period, 71% of 19,975 patients seen at the two ICUs received MRSA testing. In the pre-change period, 91% and 99% of patients at the tertiary and community hospitals received testing via culture, respectively. Culture was used 1% and ∼0% of the time at the hospitals in the post-change period. The counterfactual estimated 36 (95% CrI: 35, 37) and 32 fewer hours (95% CrI: 31, 33) until results were available at the tertiary and community hospital, respectively.ConclusionsStudy revealed MRSA results were available in less time at both facilities after testing change. This information can aid anti-microbial stewardship via possibly delaying initiation and/or quicker de-escalation of therapy when results are known.

Research on treating skin and soft tissue infections (SSTI) has shown improved patient outcomes with effective pharmaceutic prescribing. Antimicrobial stewardship programs can reduce consequences of broad-spectrum antimicrobial administration in SSTI treatment.Prospective and historic control data were collected during two 7-month periods. Intervention consisted of implementing a new SSTI evidence-based treatment algorithm and provider education, including calls and medical record notes targeted at physicians.Of 412 patients, 76 and 86 were found eligible from the historic and intervention groups, respectively. The intervention group had a higher prevalence of appropriate antibiotic usage (33% vs 19%, respectively; P = .04). There was a lower median number of days from intravenous antibiotic therapy to oral conversion (3 vs 5; P .0001) and a lower median number of days of antipseudomonal antibiotic use (3 vs 5; P = .03) in the intervention group, respectively. The intervention group also had fewer documented SSTI treatment complications (1% vs 8%, respectively; P = .04). The positive outcomes outlined demonstrate potential impacts made from the use of multidisciplinary antibiotic stewardship initiatives.Appropriate use of antimicrobial agents under the direction of an antimicrobial stewardship program can lead to improved outcomes for patients being treated for SSTIs.