Bradley Langford

Cross-sectional study of hospital antibiograms identifies areas for improvement that could help support clinical decision making & AMR monitoring:
doi.org/10.1093/jaca...
@brxad.bsky.social #JACAMRNews

Figure 2

An antibiotic audit-and-feedback intervention for family physicians targeting patients aged 65 and older was associated with a 7% reduction in antibiotic prescriptions for patients of all ages. https://ja.ma/3ImcG2W

New in JAC AMR - our review of antibiograms from 60 hospitals found ++ variability in design

Many opportunities for improvement, for ex include:
- detail about the population
- guidance on how to interpret
-info on how duplicate patients are handled

doi.org/10.1093/jaca...

#idsky

🆕 Evaluating BSI in Ontario we found #AMR was associated with a 10% ⬆️ risk of death equivalent to 1.2 deaths/100,000 people/year

These estimates are lower than those in previous literature, which may be due to robust adjustment for confounding

doi.org/10.1093/cid/...
@cidjournal.bsky.social

From @brxad.bsky.social et al, a reminder global ID collaborations do and should continue to exist and strengthen in the current political landscape. doi.org/10.1017/ash....

📈 New Public Health Ontario epidemiology report:
C. auris cases in Ontario are infrequent (22 cases, 2017–2024) but are gradually rising.
🧪 94% fluconazole resistant
🧪 35% amphotericin B resistant
🧪 0% echinocandin resistant
📊 Read more: bit.ly/4cIAwBg
#AntimicrobialStewardship

🐶🐱 Companion animals need #AntimicrobialStewardship too! In our new SR/MA (led by Dr. Fiona Emdin), we examined short vs. long antibiotic durations for UTIs in dogs & cats.📉 Pooled RR for cure = 0.55 (95% CI: 0.23–1.27), very low certainty.
🔓 doi.org/10.1186/s129...
More high-quality data needed!

Survey of US adults <65 yo comparing abx non-users to frequent users (>3x/year) in @jama.com Open

Frequent abx users more likely to distrust science, want abx for viral URIs, need health literacy support, be medical maximizers, and had more comorbidities

#IDSky

jamanetwork.com/journals/jam...

Visual abstract illustrating teaching hospitals, larger hospitals, and those with designated funding and/or resourcing for their antibiotic stewardship program were more likely to participate in antibiotic use tracking and reporting

🆕 in @ashejournal.bsky.social Another example of "you get what you pay for" - hospitals with designated funding/resources to support their antibiotic stewardship program had a 3.7X higher odds of participating in AMU reporting and benchmarking
doi.org/10.1017/ash.... #IDSky

Antibiotic Overprescription for “Urinary Tract Infections” Is Associated With Poor Diagnostic Stewardship and Low Adherence to Guidelines Purpose While urinary tract infections (UTIs) are thought to be common among women, as many as 65% of UTI diagnoses may be inaccurate. To identify strategies to improve antibiotic stewardship, we so...

UTI vs "UTI" ⁉️
In this cohort of patients diagnosed with "UTI" only about 30% had symptoms consistent with infection. ED setting and patients with mental status changes are key opportunities for antibiotic stewardship.
onlinelibrary.wiley.com/doi/10.1002/...

Shorter is greener! 🍃♻️

Unnecessary antibiotics contribute to greenhouse gas emmissions. Want to know how much? 👉🏻 shorturl.at/52wOT

Fantastic point! #IDSky #AMSsky

Local public health organizations have an important role to play in mitigating #AMR
They should be leveraged for knowledge translation/mobilization, optimizing surveillance & establishing strategic collaborations
https://doi.org/10.1093/jacamr/dlae187
@brxad.bsky.social @dianeashiru.bsky.social

CDC's Morbidity and Mortality Weekly Report (MMWR) has provided real-time data and analysis about disease outbreaks and emerging health threats without a break every week since 1960.

Until today.

Enthused that our article on BCx stewardship during the BCx shortage made the best of OFID 2024!

academic.oup.com/ofid/article...

In order to mitigate #antimicrobialresistance, we need more stewards! This scoping review shows that local public health is a key player in knowledge dissemination, data collection & design and implementation of stewardship strategies:
doi.org/10.1093/jaca...

Audit & feedback with peer comparison works to improve antibiotic prescribing in primary care. Now, health system leaders and policy-makers must take decisive steps to integrate this strategy into the healthcare system.
qualitysafety.bmj.com/content/earl...
👏 @kevinschwartz.bsky.social

We found lower rates of bacterial infection in patients with SARS-CoV-2 compared to Flu and RSV. This is driven by lower rates of co-infection (<48h) in patients with COVID. NB: testing practices may also vary across infections and over time.
doi.org/10.1093/ofid...
@ofidjournal.bsky.social #IDSky

Special thanks to Kevin Schwartz @kevinschwartz.bsky.social for his leadership and Kevin Brown, PhD for his expertise and teaching me about instrumental variable analysis!

This highlights the importance of the analytical method to reduce risk of bias when measuring abx benefits and harms in observational studies. This also supports the fact that there is no additional harm to using shorter courses and are still consistent with #shorterisbetter.

In the instrumental variable analysis we found no difference in HARMS or SAFETY outcomes across three antibiotics - cephalexin, ciprofloxacin, and amoxicillin. But interestingly when using a propensity matched analysis we did find an increase in SAFETY outcomes with long duration

Then we evaluated 117,682 community dwelling patients of those prescribers and looked at their HARMS outcomes (abx overuse) - such as AMR, side effects, C. diff, and SAFETY /balancing outcomes (abx underuse) - such as repeat Rx, hospital visits and mortality

There is a lot of of inter-prescriber variability in antibiotic duration prescribing, even after accounting for patient factors. Duration prescribing is pseudo-random! So we classified MD prescribers based on their proportion of long-duration antibiotic prescriptions - the "instrumental variable"

Evaluating Harms Associated with Prolonged Antibiotic Duration of Therapy in Community Dwelling Older Adults: A Cohort Study using Instrumental Variable Analysis In this instrumental variable analysis of 117,682 community-dwelling older adults prescribed amoxicillin, cephalexin, or ciprofloxacin, longer antibiotic c

🆕in @cidjournal.bsky.social
- our instrumental variable analysis of community-dwelling adults 66+ found that longer antibiotic courses were NOT associated with an increased benefit or harm compared to shorter courses. doi.org/10.1093/cid/...
🧵thread below #IDSky

Antibiotic stewardship programs need dedicated funding to be effective. Hospital ASPs with funding & resources use less fluoroquinolones, anti-pseudomonal agents, and clindamycin.
🆕 in @ashejournal.bsky.social
📰 doi.org/10.1017/ash....
#IDSky

Just a little nudge (stewards love nudges!) that if you get an abstract accepted at SHEA Spring, we subsequently publish the supplement with them all in it 🤩#IDSky

A vital step in reducing unnecessary antibiotic use is getting patients and the general public on board. Here are some simple resources from the Public Health Agency of Canada explaining how to use antibiotics wisely

📃 www.canada.ca/en/health-ca...

This review article provides an overview of the "basics" in leveraging ambulatory antimicrobial stewardship measures to build a sustainable program. #IDsky bit.ly/3DbzU9r

OpenAI Sora's first depiction of an antimicrobial steward defending the population from unnecessary antibiotic prescriptions! Not quite ready for a feature film. 😆
#FightAR #AntibioticResistance #IDSky

SRMA of Antibiotic Audit and Feedback in Primary Care:
💊11% ⬇️prescribing volume
▶️23%⬇️in unnecessary initiation
💣17% ⬇️in broad-spectrum selection
🗓️13%⬇️in prolonged duration
doi.org/10.1093/cid/ci…
Great work by @kevinschwartz.bsky.social and team via @cidjournal.bsky.social