Say it ain't Steno: a microbiology nudge comment leads to less treatment of Stenotrophomonas maltophilia respiratory colonization
Recommended Citation
Boettcher SR, Kenney RM, Arena CJ, Beaulac AE, Tibbetts RJ, Shallal AB, Suleyman G, and Veve MP. Say it ain't Steno: a microbiology nudge comment leads to less treatment of Stenotrophomonas maltophilia respiratory colonization. Infect Control Hosp Epidemiol 2024; 1-5.
Document Type
Article
Publication Date
12-3-2024
Publication Title
Infection control and hospital epidemiology
Abstract
OBJECTIVE: To describe the effect of a Stenotrophomonas maltophilia (SM) respiratory culture nudge on antibiotic use in colonized patients. DESIGN: IRB-approved quasi-experiment.
SETTING: Five acute-care hospitals in Michigan. PATIENTS: Adult patients with SM respiratory culture between 01/01/2022 and 01/27/2023 (pre-nudge) and 03/27/2023-12/31/2023 (post-nudge). Patients with active community/hospital/ventilator-acquired pneumonia or who received SM-targeted antibiotics at the time of culture were excluded.
METHODS: A nudge comment was implemented 02/2023 stating: "S. maltophilia is a frequent colonizer of the respiratory tract. Clinical correlation for infection is required. Colonizers do not require antibiotic treatment." The primary outcome was no treatment with SM-therapy; secondary outcomes were treatment with SM-therapy ≥72 hrs, length of stay, and in-hospital, all-cause mortality. Safety outcomes included antibiotic-associated adverse drug events (ADEs).
RESULTS: 94 patients were included: 53 (56.4%) pre- and 41 (43.6%) post-nudge. Most patients were men (53, 56.4%), had underlying lung disease (61, 64.8%), and required invasive ventilatory support (70, 74.5%). Eleven (11.7%) patients resided in a long-term care facility. No treatment with SM therapy was observed in 13 (23.1%) pre- versus 32 (78.0%) post-nudge patients (P <0.001). There were no differences in secondary outcomes. Antibiotic-associated ADEs were common (33/41, 76%) in patients who received ≥72hrs of SM-therapy: fluid overload (18, 44%), hyponatremia (17, 42%), elevated SCr (12, 29%), hyperkalemia (5, 12%). After adjustment for confounders, post-nudge was associated with 11-fold increased odds of no treatment with SM-therapy (adjOR, 11.72; 95%CI, 4.18-32.83).
CONCLUSIONS: A targeted SM nudge was associated with a significant reduction in treatment of colonization, with similar patient outcomes. SM-treated patients frequently developed antibiotic-associated ADEs.
PubMed ID
39623552
ePublication
ePub ahead of print
First Page
1
Last Page
5
