Antibiotic utilization trends in Veterans Affairs patients with bloodstream infections.

Objective: is a multidrug-resistant gram-negative bacillus that can cause serious infections but has limited treatment options. This study aims to establish trends in the treatment of bloodstream infections (BSI) across the United States in Department of Veterans Affairs (VA) facilities.

Methods: Data was evaluated over a 10-year timeframe (2012 to 2021) in this retrospective cohort study.

Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019.

Objective: The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts.

Veteran influenza vaccination acceptance rates after completion of the COVID-19 vaccination series among historical influenza vaccine refusers.

Background: Vaccine hesitancy remains an obstacle in disease prevention. The recent COVID-19 pandemic highlighted this issue and may influence acceptance of other recommended immunizations. The objective of this study was to determine the association between receiving the COVID-19 vaccination and the subsequent acceptance of the influenza vaccination in a Veteran population that historically declined influenza vaccination.

Clinical outcomes associated with guideline-discordant management of asymptomatic bacteriuria and urinary tract infection in hospitalized patients with neurogenic bladder.

Objective: To compare clinical outcomes associated with appropriate and inappropriate management of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) among inpatients with neurogenic bladder (NB).

Design: Multicenter, retrospective cohort.

Setting: The study was conducted across 4 Veterans' Affairs hospitals.

Evaluating the Impact of a Urinalysis to Reflex Culture Process Change in the Emergency Department at a Veterans Affairs Hospital.

Background: Although automated urine cultures (UCs) following urinalysis (UA) are often used in emergency departments (EDs) to identify urinary tract infections (UTIs), results are often reported as no organism growth or the growth of clinically insignificant organisms, leading to the overdetection and overtreatment of asymptomatic bacteriuria (ASB).

Methods: A process change was implemented at a US Department of Veterans Affairs medical center ED that automatically cancelled UCs if UAs had < 5 white blood cells per high-power field (WBC/HPF). An option for do not cancel (DNC) UC was available.

Uptake in newly approved antibiotics prescribed to patients with carbapenem-resistant Enterobacterales (CRE).

We assessed trends in treatment of patients with CRE from 2012 through 2018. We detected decreased utilization of aminoglycosides and colistin and increased utilization in extended-spectrum cephalosporins and ceftazidime-avibactam. We found significant uptake of ceftazidime-avibactam, a newly approved antibiotic, to treat CRE infections.

Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans' Affairs (VA) dentistry.

Objective: United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections.

Development of a 51-hospital Chicagoland regional antibiogram and comparison to local hospital and national surveillance data.

Objective: To develop a regional antibiogram within the Chicagoland metropolitan area and to compare regional susceptibilities against individual hospitals within the area and national surveillance data.

Design: Multicenter retrospective analysis of antimicrobial susceptibility data from 2017 and comparison to local institutions and national surveillance data.

Setting And Participants: The analysis included 51 hospitals from the Chicago-Naperville-Elgin Metropolitan Statistical Area within the state of Illinois.

Long-term prescribing of nitrofurantoin for urinary tract infections (UTI) in veterans with spinal cord injury (SCI).

Context/objective: To evaluate the impact of long-term nitrofurantoin for UTI prophylaxis in veterans with SCI.

Design: Matched pairs study.

Setting: Veterans cared for at VA facilities from 10/1/2012-9/30/2013.

Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures.

Background: Guidelines for antibiotics prior to dental procedures for patients with specific cardiac conditions and prosthetic joints have changed, reducing indications for antibiotic prophylaxis. In addition to guidelines focused on patient comorbidities, systematic reviews specific to dental extractions and implants support preprocedure antibiotics for all patients. However, data on dentist adherence to these recommendations are scarce.

Evaluation of Bacteriuria Treatment and Follow-up Initiated in the Emergency Department at a Veterans Affairs Hospital.

This study aims to evaluate the treatment and follow-up of bacteriuria in the emergency department (ED). The primary objective was to determine the frequency of patients discharged from the ED with antibiotics for symptomatic and asymptomatic bacteriuria, and the secondary objectives were to determine the frequency of patients receiving postdischarge antibiotic interventions and antibiotic-related adverse drug reactions (ADRs). This retrospective study evaluated patients with ED urine cultures sent between October 1, 2015, and November 24, 2015.

Ertapenem-associated neurotoxicity in the spinal cord injury (SCI) population: A case series.

Context Ertapenem, a broad spectrum carbapenem antibiotic, is used often in Spinal Cord Injury (SCI) patients due to increased risk factors for multi-drug resistant (MDR) infections in this population. Neurotoxicity, specifically seizures, due to ertapenem is a known adverse effect and has been described previously. Other manifestations such as delirium and visual hallucinations have rarely been reported, and no literature, to the best of our knowledge, specifically describes these effects solely in the SCI population.

Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013-14.

Background: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection.

Objectives: To describe the spectrum and clinical impact of co-infections.

Successful Treatment of Multi-Drug Resistant Pseudomonas aeruginosa Bacteremia with the Recommended Renally Adjusted Ceftolozane/Tazobactam Regimen.

Introduction: Ceftolozane/tazobactam (C/T) is a novel antibiotic approved for complicated intra-abdominal and urinary tract infections caused by Gram-positive and Gram-negative organisms, including some MDR strains. Little is known about the use of this agent for treatment of bacteremia and even less so about the appropriateness of the renally defined regimens. We describe a case of a 66-year-old man with a history of chronic kidney disease (baseline Cr = 3-4 mg/dl) and recurrent nephrolithiasis with bilateral stents who had positive concurrent urine and blood cultures for MDR Pseudomonas aeruginosa (PSA), susceptible only to amikacin and colistin.

Outcomes of ceftriaxone use compared to standard of therapy in methicillin susceptible staphylococcal aureus (MSSA) bloodstream infections.

Background: Standard of care therapy (SOCT) for the treatment of methicillin susceptible staphylococcal aureus (MSSA) infections requires multiple daily infusions. Despite questionable efficacy due to high protein binding, ceftriaxone (CTX) is frequently used for treatment of MSSA at Hines VA Hospital.

Objective: The objective of this study was to determine clinical and microbiological outcomes in patients with MSSA bacteremia treated with CTX compared to SOCT.

Rifaximin Redux: treatment of recurrent Clostridium difficile infections with rifaximin immediately post-vancomycin treatment.

We report our continued experience with rifaximin as a post-vancomycin treatment strategy in six patients with multiple recurrences of C. difficile infection (CDI). Four of the six patients (67%) had no further diarrhea episodes, but two patients failed shortly after or during the rifaximin treatment.