The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia.

A β-lactam plus a macrolide or a respiratory fluoroquinolone alone is recommended as standard empiric antibacterial therapy for non-severe adults hospitalized with community-acquired pneumonia (CAP) per Infectious Diseases Society of America guidelines. However, the evidence in support of adding empiric atypical antibacterial therapy, and specifically the addition of a macrolide, is conflicting and should be balanced with additional factors: the necessity of covering atypical organisms, benefits of macrolide-associated immunomodulation, harms associated with antibiotic use, and selection for antibiotic-resistant organisms. In this review, we examine the role of atypical coverage in standard treatment regimens for patients admitted with non-severe CAP and specifically focus on the addition of macrolides to β-lactams.

Antimicrobial stewardship and quality improvement strategies in critical access hospitals: a process evaluation of an intensive quality improvement cohort.

We describe our experience implementing an intensive quality improvement cohort pilot focused on managing asymptomatic bacteriuria in 19 critical access hospitals. Participation in the pilot was high, and almost all sites identified an improvement goal and collected clinical data. Barriers to implementation included staffing shortages, turnover, and lack of bandwidth.

Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention.

Background: Asymptomatic bacteriuria (ASB) treatment is a common form of antibiotic overuse and diagnostic error. Antibiotic stewardship using the inappropriate diagnosis of urinary tract infection (ID-UTI) measure has reduced ASB treatment in diverse hospitals. However, critical access hospitals (CAHs) have differing resources that could impede stewardship.

Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment.

We evaluated the prevalence and treatment of asymptomatic bacteriuria (ASB) in 17 critical-access hospitals. Among 891 patients with urine cultures from September 2021 to June 2022, 170 (35%) had ASB. Also, 76% of patients with ASB received antibiotics for a median duration of 7 days, demonstrating opportunities for antimicrobial stewardship.