In June of 2024, Becton Dickinson experienced a blood culture bottle shortage for their BACTEC system, forcing health systems to reduce usage or risk exhausting their supply. Virginia Commonwealth University Health System (VCUHS) in Richmond, VA decided that it was necessary to implement austerity measures to preserve the blood culture bottle supply.

VCUHS includes a main campus in Richmond, VA as well as two affiliate hospitals in South Hill, VA (Community Memorial Hospital (CMH)) and Tappahannock Hospital in Tappahannock, VA. It also includes a free-standing Emergency Department in New Kent, VA.

Blood cultures from both pediatric and adult patients were included in this study.

VCUHS intervened to decrease blood culture utilization across the entire health system. Interventions included communication of blood culture guidance as well as an electronic health record order designed to guide providers and discourage wasteful ordering.

Post-implementation analyses showed that interventions reduced overall usage by 35.6% (P < .0001) and by greater than 40% in the Emergency Departments. The impact of these changes in utilization on positivity were analyzed, and it was found that the overall positivity rate increased post-intervention from 8.8% to 12.1% (P = .0115) and in the ED specifically from 10.2% to 19.5% (P < .0001).

These findings strongly suggest that some basic stewardship interventions can significantly change blood culture practice in a manner that minimizes the impact on patient care.

This study aimed to evaluate appropriate antimicrobial prescribing after implementing a pneumonia order set within a community teaching hospital.

Retrospective chart review study.

450-bed community teaching hospital.

Patients who are 18 years of age or older admitted for treatment of community-acquired pneumonia (CAP) between October 1, 2021, and August 1, 2023.

This retrospective cohort study aimed to evaluate a composite endpoint of appropriate empiric antimicrobial selection, dosing, and duration in accordance with the national guidelines after the implementation of a CAP order set. Secondary outcomes included comparing hospital length of stay (LOS), readmission rates, mortality rates, and Clostridium difficile infection rates.

A total of 236 patients were included (118 patients per group). Significantly more patients in the post-implementation group received guideline-concordant therapy for CAP (5.9% vs 35.6%, P < .001). Results were heavily influenced by improvements in appropriate durations of therapy (pre: 6.8% vs post: 39.9%, P < .001). There were no significant differences observed for LOS, 30-day readmission rates, C. difficile infections within 30 days, or mortality rates between groups. The order set was utilized in 66.1% of patients included in the post-implementation group.

Implementing an order set significantly improved inpatient antibiotic prescribing for CAP with no difference in clinical or safety outcomes. Antibiotic order sets will be a useful tool for antimicrobial stewardship program expansion into other common community-acquired infections.

Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious and subconscious impact various educational materials (informational handout, priming poster, and commitment poster) had on urgent care patients’ knowledge and expectations regarding antibiotics.

Stratified Block Randomized Control Trial.

Urgent care centers (UCCs) in Colorado, Florida, Georgia, and New Jersey.

Urgent care patients.

We randomized 29 UCCs across six study arms to display specific educational materials (informational handout, priming poster, and commitment poster). The primary intention-to-treat (ITT) analysis evaluated whether the materials impacted patient knowledge or expectations of antibiotic prescribing by assigned study arm. The secondary as-treated analysis evaluated the same outcome comparing patients who recalled seeing the assigned educational material and patients who either did not recall seeing an assigned material or were in the control arm.

Twenty-seven centers returned 2,919 questionnaires across six study arms. Only 27.2% of participants in the intervention arms recalled seeing any educational materials. In our primary ITT analysis, no difference in knowledge or expectations of antibiotic prescribing was noted between groups. However, in the as-treated analysis, the handout and commitment poster were associated with higher antibiotic knowledge scores.

Educational materials in UCCs are associated with increased antibiotic-related knowledge among patients when they are seen and recalled; however, most patients do not recall passively displayed materials. More emphasis should be placed on creating and drawing attention to memorable patient educational materials.

This qualitative study aimed to understand facilitators and barriers to implementation of interventions to improve guideline-concordant antibiotic duration prescribing for pediatric acute otitis media (AOM).

Clinicians and clinic administrators participated in semi-structured qualitative interviews, and parents of children 2 years of age or older with a recent diagnosis of AOM participated in focus groups. The Practical Robust Implementation and Sustainability Model (PRISM) guided the study. Interviews were analyzed using the Rapid Assessment Process.

Denver Health and Hospital Authority (Denver, CO) led the study. Recruitment occurred at Vanderbilt University Medical Center (Nashville, TN) and Washington University in St. Louis Medical Center (St. Louis, MO).

Purposeful sampling was used to recruit clinicians and administrators for qualitative interviews. Convenience sampling was used to recruit parents for focus groups.

Thirty-one participants (15 clinicians, 4 administrators, and 12 parents) engaged in interviews and focus groups. Factors influencing antibiotic prescribing included patient history, years of practice, familiarity with the patient, concerns with patient medication adherence, and practice type. Clinicians endorsed electronic health record modifications and clinician prescribing feedback as methods to improve patient care and reduce the durations of prescribed antibiotics. Suggestions for intervention optimization and education needs were also obtained.

Findings suggest that clinicians and administrators support reducing prescribed antibiotic durations for AOM and are receptive to the proposed interventions. More education is needed to increase parent awareness about antibiotic stewardship and AOM treatment options.

RELAX: Reducing Length of Antibiotics for Children with Ear Infections (RELAX), NCT05608993, https://clinicaltrials.gov/study/NCT05608993.