Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-17 (of 17 Records) |
Query Trace: Sanchez GV [original query] |
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Antibiotic stewardship in outpatient telemedicine: Adapting Centers for Disease Control and Prevention core elements to optimize antibiotic use
Sanchez GV , Kabbani S , Tsay SV , Bizune D , Hersh AL , Luciano A , Hicks LA . Telemed J E Health 2023 The rapid expansion of telemedicine has highlighted challenges and opportunities to improve antibiotic use and effectively adapt antibiotic stewardship best practices to outpatient telemedicine settings. Antibiotic stewardship integration into telemedicine is essential to optimize antibiotic prescribing for patients and ensure health care quality. We performed a narrative review of published literature on antibiotic prescribing and stewardship in outpatient telemedicine to inform the adaptation of the Core Elements of Outpatient Antibiotic Stewardship framework to outpatient telemedicine settings. Our narrative review suggests that in-person antibiotic stewardship interventions can be adapted to outpatient telemedicine settings. We present considerations for applying the Core Elements of Outpatient Antibiotic Stewardship to outpatient telemedicine which builds upon growing evidence describing care delivery and quality improvement in this setting. Additional applied implementation research is necessary to inform the application of effective, sustainable, and equitable antibiotic stewardship interventions across the spectrum of outpatient telemedicine. |
Comparison of antibiotic prescribing between physicians and advanced practice clinicians
Hersh AL , Shapiro DJ , Sanchez GV , Hicks LA . Infect Control Hosp Epidemiol 2023 1-3 We compared antibiotic prescribing rates for respiratory conditions in a national sample of outpatient visits from 2010 to 2018 between physicians and advanced practice clinicians (APCs). APCs prescribed antibiotics more frequently than physicians (58% vs 52%), but there were no differences in selection of guideline recommended first-line agents between specialties. |
Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes.
Penna AR , Hunter JC , Sanchez GV , Mohelsky R , Barnes LEA , Benowitz I , Crist MB , Dozier TR , Elbadawi LI , Glowicz JB , Jones H , Keaton AA , Ogundimu A , Perkins KM , Perz JF , Powell KM , Cochran RL , Stone ND , White KA , Weil LM . J Public Health Manag Pract 2022 28 (6) 682-692 CONTEXT: Between April 2020 and May 2021, the Centers for Disease Control and Prevention (CDC) awarded more than $40 billion to health departments nationwide for COVID-19 prevention and response activities. One of the identified priorities for this investment was improving infection prevention and control (IPC) in nursing homes. PROGRAM: CDC developed a virtual course to train new and less experienced public health staff in core healthcare IPC principles and in the application of CDC COVID-19 healthcare IPC guidance for nursing homes. IMPLEMENTATION: From October 2020 to August 2021, the CDC led training sessions for 12 cohorts of public health staff using pretraining reading materials, case-based scenarios, didactic presentations, peer-learning opportunities, and subject matter expert-led discussions. Multiple electronic assessments were distributed to learners over time to measure changes in self-reported knowledge and confidence and to collect feedback on the course. Participating public health programs were also assessed to measure overall course impact. EVALUATION: Among 182 enrolled learners, 94% completed the training. Most learners were infection preventionists (42%) or epidemiologists (38%), had less than 1 year of experience in their health department role (75%), and had less than 1 year of subject matter experience (54%). After training, learners reported increased knowledge and confidence in applying the CDC COVID-19 healthcare IPC guidance for nursing homes (≥81%) with the greatest increase in performing COVID-19 IPC consultations and assessments (87%). The majority of participating programs agreed that the course provided an overall benefit (88%) and reduced training burden (72%). DISCUSSION: The CDC's virtual course was effective in increasing public health capacity for COVID-19 healthcare IPC in nursing homes and provides a possible model to increase IPC capacity for other infectious diseases and other healthcare settings. Future virtual healthcare IPC courses could be enhanced by tailoring materials to health department needs, reinforcing training through applied learning experiences, and supporting mechanisms to retain trained staff. |
Pediatric medicaid visits for soil-transmitted helminth infections in the black belt region-Alabama, 2010-2018
Sanchez GV , Blackstock AJ , Davidson SL . Am J Trop Med Hyg 2022 106 (3) 867-869 Areas of rural Alabama may be at risk for re-emergence of soil-transmitted helminthiasis (STH) where environmental conditions are favorable for STH transmission, including in the agricultural Black Belt region. We describe pediatric Medicaid STH visits in Alabama and compare STH visit rates in Black Belt counties with those of non-Black Belt counties. Alabama Medicaid visit claims among children aged 0-18 years who received an STH diagnosis during January 2010-December 2018 were examined. STH-related pediatric visits were uncommon, but several counties with higher STH rates were identified. Visit rates did not differ meaningfully when comparing Black Belt with non-Black Belt region counties (rate ratio: 1.10; 95% CI: 0.73-1.64). Additional studies examining STH prevalence among children living in communities at risk for STH in Alabama can further clarify STH burden and identify communities experiencing environmental and sanitation conditions favorable to STH endemicity. |
Pneumococcal Disease Outbreak at a State Prison, Alabama, USA, September 1-October 10, 2018(1)
Sanchez GV , Bourne CL , Davidson SL , Ellis M , Feldstein LR , Fay K , Brown NE , Geeter EF , Foster LL , Gilmore C , McIntyre MG , Taylor B , Velusamy S , Chochua S , Matanock AM . Emerg Infect Dis 2021 27 (7) 1949-1952 A pneumococcal disease outbreak caused by Streptococcus pneumoniae serotype 12F occurred in a state prison in Alabama, USA. Among 1,276 inmates, 40 cases were identified (3 confirmed, 2 probable, 35 suspected). Close living quarters, substance use, and underlying conditions likely contributed to disease risk. Prophylaxis for close contacts included azithromycin and 23-valent pneumococcal polysaccharide vaccine. |
Facility-Wide Testing for SARS-CoV-2 in Nursing Homes - Seven U.S. Jurisdictions, March-June 2020.
Hatfield KM , Reddy SC , Forsberg K , Korhonen L , Garner K , Gulley T , James A , Patil N , Bezold C , Rehman N , Sievers M , Schram B , Miller TK , Howell M , Youngblood C , Ruegner H , Radcliffe R , Nakashima A , Torre M , Donohue K , Meddaugh P , Staskus M , Attell B , Biedron C , Boersma P , Epstein L , Hughes D , Lyman M , Preston LE , Sanchez GV , Tanwar S , Thompson ND , Vallabhaneni S , Vasquez A , Jernigan JA . MMWR Morb Mortal Wkly Rep 2020 69 (32) 1095-1099 Undetected infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) contributes to transmission in nursing homes, settings where large outbreaks with high resident mortality have occurred (1,2). Facility-wide testing of residents and health care personnel (HCP) can identify asymptomatic and presymptomatic infections and facilitate infection prevention and control interventions (3-5). Seven state or local health departments conducted initial facility-wide testing of residents and staff members in 288 nursing homes during March 24-June 14, 2020. Two of the seven health departments conducted testing in 195 nursing homes as part of facility-wide testing all nursing homes in their state, which were in low-incidence areas (i.e., the median preceding 14-day cumulative incidence in the surrounding county for each jurisdiction was 19 and 38 cases per 100,000 persons); 125 of the 195 nursing homes had not reported any COVID-19 cases before the testing. Ninety-five of 22,977 (0.4%) persons tested in 29 (23%) of these 125 facilities had positive SARS-CoV-2 test results. The other five health departments targeted facility-wide testing to 93 nursing homes, where 13,443 persons were tested, and 1,619 (12%) had positive SARS-CoV-2 test results. In regression analyses among 88 of these nursing homes with a documented case before facility-wide testing occurred, each additional day between identification of the first case and completion of facility-wide testing was associated with identification of 1.3 additional cases. Among 62 facilities that could differentiate results by resident and HCP status, an estimated 1.3 HCP cases were identified for every three resident cases. Performing facility-wide testing immediately after identification of a case commonly identifies additional unrecognized cases and, therefore, might maximize the benefits of infection prevention and control interventions. In contrast, facility-wide testing in low-incidence areas without a case has a lower proportion of test positivity; strategies are needed to further optimize testing in these settings. |
Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities - Detroit, Michigan, March-May 2020.
Sanchez GV , Biedron C , Fink LR , Hatfield KM , Polistico JMF , Meyer MP , Noe RS , Copen CE , Lyons AK , Gonzalez G , Kiama K , Lebednick M , Czander BK , Agbonze A , Surma AR , Sandhu A , Mika VH , Prentiss T , Zervos J , Dalal DA , Vasquez AM , Reddy SC , Jernigan J , Kilgore PE , Zervos MJ , Chopra T , Bezold CP , Rehman NK . MMWR Morb Mortal Wkly Rep 2020 69 (27) 882-886 Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs. |
Antibiotic therapy duration in US adults with sinusitis
King LM , Sanchez GV , Bartoces M , Hicks LA , Fleming-Dutra KE . JAMA Intern Med 2018 178 (7) 992-994 This study evaluates the duration of antibiotic therapy prescribed for US adults with sinusitis. |
Outpatient macrolide antibiotic prescribing in the United States, 2008-2011
Sanchez GV , Shapiro DJ , Hersh AL , Hicks LA , Fleming-Dutra KE . Open Forum Infect Dis 2017 4 (4) ofx220 National Ambulatory Medical Care Survey data were used to assess outpatient macrolide prescribing and selection. Conditions for which macrolides are firstline therapy represented 5% of macrolide prescribing. Family practitioners selected macrolides for children more frequently than pediatricians. Macrolides are an important antibiotic stewardship target. |
Core elements of outpatient antibiotic stewardship
Sanchez GV , Fleming-Dutra KE , Roberts RM , Hicks LA . MMWR Recomm Rep 2016 65 (6) 1-12 The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings. |
Outpatient antibiotic prescribing among United States nurse practitioners and physician assistants
Sanchez GV , Hersh AL , Shapiro DJ , Cawley JF , Hicks LA . Open Forum Infect Dis 2016 3 (3) ofw168 We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs. |
Outpatient antibiotic prescribing practices for uncomplicated urinary tract infection in women in the United States, 2002-2011
Kobayashi M , Shapiro DJ , Hersh AL , Sanchez GV , Hicks LA . Open Forum Infect Dis 2016 3 (3) ofw159 Background. Urinary tract infection (UTI) is one of the most common diagnoses leading to an antibiotic prescription for women seeking ambulatory care. Understanding current national outpatient antibiotic prescribing practices will help ongoing stewardship efforts to optimize antibiotic use; however, information on recent national outpatient antibiotic prescribing trends for UTI is limited. Methods. We analyzed the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011. Outpatient visits of women aged ≥18 years with a diagnosis of uncomplicated UTI were included for analysis. We conducted weighted descriptive analyses, examined time trends in antibiotic prescribing, and used multivariable logistic regression to identify patient and provider factors associated with fluoroquinolone prescribing. Results. A total of 7111 visits were identified. Eighty percent of visits resulted in an antibiotic prescription; fluoroquinolones were the most frequently prescribed antibiotics throughout the study period (49% overall). Older patients (adjusted odds ratio [AOR] for adults aged ≥70 years = 2.5; 95% confidence interval [CI], 1.6-3.8) and patients treated by internists (AOR = 2.0; 95% CI, 1.1-3.3) were more likely than younger patients and those treated by family practitioners to receive fluoroquinolones. Outpatient visits in the West US Census region were less likely to be associated with fluoroquinolone prescribing (AOR = 0.6; 95% CI, .4-1.0) compared with visits in the Northeast. Conclusions. Fluoroquinolones were the most frequently selected antibiotic treatment for uncomplicated UTI in women during the study period. Outpatient antibiotic stewardship initiatives should include efforts to reduce overuse of fluoroquinolones for uncomplicated UTI. |
Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011
Fleming-Dutra KE , Hersh AL , Shapiro DJ , Bartoces M , Enns EA , File TM Jr , Finkelstein JA , Gerber JS , Hyun DY , Linder JA , Lynfield R , Margolis DJ , May LS , Merenstein D , Metlay JP , Newland JG , Piccirillo JF , Roberts RM , Sanchez GV , Suda KJ , Thomas A , Woo TM , Zetts RM , Hicks LA . JAMA 2016 315 (17) 1864-73 IMPORTANCE: The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. OBJECTIVE: To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. DESIGN, SETTING, AND PARTICIPANTS: Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. EXPOSURES: Ambulatory care visits. MAIN OUTCOMES AND MEASURES: Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. RESULTS: Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. CONCLUSIONS AND RELEVANCE: In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship. |
Minimizing antibiotic misuse through evidence-based management of outpatient acute respiratory infections
Sanchez GV , Fleming-Dutra KE , Hicks LA . Antimicrob Agents Chemother 2015 59 (10) 6673 It was with considerable interest that we read the study by Schroeck et al. (1), which assessed the appropriateness of treatment for acute respiratory infections (ARIs) in the Veterans Affairs Western New York Healthcare System. These infections represent a large portion of injudicious antibiotic use among outpatients, and we applaud the authors for focusing on these conditions in the veteran population. However, we would like to clarify that clinical practice guidelines regarding the management of ARIs are published by professional societies such as the Infectious Diseases Society of America (IDSA) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and not by the Centers for Disease Control and Prevention (CDC). The CDC's Get Smart: Know When Antibiotics Work Program consolidates recommendations from the different guidelines into easy-to-use resources to help clinicians optimize outpatient antibiotic therapy (2). Although the authors cite the Get Smart Program as providing the criteria to diagnose and manage ARIs, the definitions of the clinical conditions presented do not accurately reflect current clinical practice guidelines or current Get Smart recommendations. |
CDC Grand Rounds: getting smart about antibiotics
Demirjian A , Sanchez GV , Finkelstein JA , Ling SM , Srinivasan A , Pollack LA , Hicks LA , Iskander JK . MMWR Morb Mortal Wkly Rep 2015 64 (32) 871-873 Each year in the United States, approximately two million persons become infected with antibiotic-resistant bacteria, at least 23,000 persons die as a direct result of these infections, and many more die from conditions complicated by a resistant infection. Antibiotic-resistant infections contribute to poor health outcomes, higher health care costs, and use of more toxic treatments. Although emerging resistance mechanisms are being identified and resistant infections are on the rise, new antibiotic development has slowed considerably. |
Knowledge and attitudes regarding antibiotic use among adult consumers, adult Hispanic consumers, and health care providers - United States, 2012-2013
Francois Watkins LK , Sanchez GV , Albert AP , Roberts RM , Hicks LA . MMWR Morb Mortal Wkly Rep 2015 64 (28) 767-70 Appropriate antibiotic use, in particular avoidance of antibiotics for upper respiratory infections likely to be caused by viruses, is a key component of efforts to slow the increase in antibiotic-resistant infections. Studies suggest that Hispanic consumers might differ from non-Hispanic consumers in their knowledge and attitudes regarding antibiotic use. To better understand health care provider and consumer knowledge and attitudes that influence antibiotic use, CDC analyzed national internet survey data collected from participants living in the United States during 2012-2013. The participants represented three groups: 1) the total population of adult consumers (all ethnicities); 2) adult Hispanic consumers; and 3) health care providers. Hispanic consumers were more likely than all consumers to believe that if they have a cold, antibiotics would help them to get better more quickly (48% versus 25%), and more likely to obtain antibiotics not prescribed by a clinician, such as antibiotics left over from a previous illness (25% versus 9%), obtained from a neighborhood grocery store (23% versus 5%), or obtained from a friend or family member (17% versus 6%). Most providers surveyed (54%) reported that they believed their patients expect antibiotics during visits for a cough or cold, whereas 26% of all consumers reported this expectation. To maximize knowledge about appropriate antibiotic use among outpatients in the United States, public health initiatives should target Hispanic as well as general audiences. |
Acute sinusitis and pharyngitis as inappropriate indications for antibiotic use
Sanchez GV , Hicks LA . Antimicrob Agents Chemother 2014 58 (6) 3572 We read with interest the study by Donnelly and colleagues (1) which explored antibiotic prescriptions for ambulatory emergency department (ED) visits in the United States. As public health researchers, we agree with the authors' assertion that their findings “highlight opportunities for reducing inappropriate antibiotic use among adult ED ARTI [acute respiratory tract infection] patients and for optimizing treatment for antibiotic-appropriate ARTI” (1). However, these study results should be interpreted with one important clarification regarding the categories in which infections were classified. | In this work, the authors define “antibiotic-appropriate” ARTIs as otitis media, sinusitis, pharyngitis, and nonviral pneumonia. However, it is well established that sinusitis and pharyngitis are caused predominantly by viral pathogens. In acute rhinosinusitis, for instance, the incidence of bacterial infections is estimated to be only 2% to 10%, with a secondary bacterial infection occurring in approximately 0.5% to 2% of adult cases (2). Similarly, group A streptococcal (GAS) pharyngitis, the primary indication to treat a sore throat with an antibiotic, accounts for only 5% to 15% of cases among adults and 20% to 30% of such visits for children (3). Recent clinical practice guidelines emphasize using strict diagnostic criteria to establish a bacterial diagnosis for these infections, as well as the use of first-line targeted antibiotics, such as penicillin and amoxicillin (2, 4). |
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