Impact of the Centers for Medicare and Medicaid Services Sepsis Core Measure on Antibiotic Use.

Autor:	Pakyz AL; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia, USA., Orndahl CM; Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA., Johns A; Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA., Harless DW; Department of Economics, Virginia Commonwealth University School of Business, Richmond, Virginia, USA., Morgan DJ; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland, USA., Bearman G; Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University Health System, Richmond, Virginia, USA., Hohmann SF; Vizient, Inc, Chicago, Illinois, USA.; Department of Health Systems Management, Rush University, Chicago, Illinois, USA., Stevens MP; Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Feb 16; Vol. 72 (4), pp. 556-565.
DOI:	10.1093/cid/ciaa456
Abstrakt:	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. (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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