Background: Penicillin discovered in 1928 by Sir Alexander Fleming, beginning of the antibiotic revolution. Penicillin as helped increase average life Span in USA from 47 years to 78.8 years. Beta lactam account to about 40% of total antibiotic use every year. 10% of patients in U.S. report penicillin allergy, but 9 out of 10 patients […]

Background: Sepsis is one of the most common causes for adult emergency department admissions and carries high morbidity and mortality. Appropriate and timely administration of intravenous (IV) antibiotics is one of the cornerstones of initial management of sepsis. Indeed, mortality has been shown to increase by 7-14% for each hour of delay in antibiotic administration. […]

Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (non-infectious/non-bacterial syndrome, e.g., asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1-3 However, it is unknown whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes. […]

Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014 and December 31, […]

Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have non-bacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked at the […]

Background: Antibiotics prescribed at hospital discharge account for over half of antibiotic exposure related to hospitalization and contribute to antibiotic-related harm. We hypothesized that an antibiotic timeout to reconsider antibiotic necessity, selection, and duration prior to discharge could reduce antibiotic overuse. Thus, we conducted a 6 month prospective, controlled pilot study to determine feasibility and […]

Background: On January 1st, 2017, the Joint Commission antibiotic stewardship accreditation standard came into effect, requiring hospital wide antibiotic stewardship programs. In West Virginia, per the CDC, in 2014, less than 28% had a stewardship program that met all 7 of the CDC core elements. In a May 2017 article of Clinical Infectious Diseases, authors […]

Case Presentation: A 38-year-old woman with well-controlled Crohn’s disease on immunosuppression presented to the emergency department with a three- day history of rash and fevers following antimicrobial treatment at an outside urgent care facility for presumed bacterial sinusitis. At the urgent care facility, she had received intramuscular ceftriaxone, oral azithromycin, and oral prednisone. The following […]