VA studies highlight collaborative antimicrobial stewardship effort

Two new studies by Veterans Affairs (VA) clinicians and researchers highlight how telemedicine can support antimicrobial stewardship programs at rural VA hospitals.

The studies, published yesterday in Infection Control & Hospital Epidemiology, describe recommendations, staffing, and workload associated with Videoconference Antimicrobial Stewardship Teams (VASTs), which connect rural VA medical centers (VAMCs) with limited access to stewardship specialists by video to an infectious disease (ID)-trained VA physician.

The program, expanded in 2021 after a pilot program proved successful, pairs eight ID specialists from large VAMCs with 10 rural VA hospitals for regularly scheduled meetings to discuss clinical cases.

In the first study, researchers reviewed the types of clinical cases discussed and the recommendations made during VAST meetings over the first 15 months of the partnerships. Of the 626 cases reviewed, the most common clinical syndromes discussed were respiratory (29%) and urinary tract (21%) infections. Of the 973 recommendations made, 71% were accepted within a week of the VAST meeting, including 80% of the 570 recommendations relating to antibiotics. 

Interviews conducted with VAST participants revealed that positive communication, the collaborative nature of the format, and the time provided for discussion of recommendations helped build trust and contributed to the acceptance of recommendations.

“The results indicate that VASTs have been successful in supporting Antimicrobial Stewardship activities at VAMCs that do not have ID-trained physicians or pharmacists on staff,” the study authors wrote.

Format is cost-effective

In the second study, the same VA researchers assessed workload estimates based on the time the ID consultants and antimicrobial stewardship champions at rural VAMCs were allocated to VAST activities. While they identified some opportunities to improve workflow efficiency, they found, overall, that the approach was cost-effective and sustainable.

The authors say future work will assess outcomes associated with VASTs and aim to identify which aspects of the program are associated with successful stewardship efforts. 

Quick takes: BioNTech closures; Texas alert on New World screwworm; second Saluda County, SC, measles case

• BioNTech announced today it would close sites in Germany and Singapore, affecting up to 1,860 jobs, and buy back up to $1 billion of its shares, as the COVID‑19 vaccine maker is transitioning away from pandemic-era manufacturing and prepares for a leadership transition. BioNTech, along with Pfizer, developed the mRNA COVID-19 vaccine Comirnaty. The German company said it would pivot from COVID-19 vaccines and focus instead on oncology therapies. 
• The first confirmed detection of New World screwworm in the Mexican state of Coahuila has prompted Texas officials to issue a warning about agricultural risks in that state. “This screwworm detection in Coahuila is a serious wake-up call. New World screwworm has now been found only 119 miles from the Texas border—at roughly the same latitude as Zapata, Texas, and north and west of the Rio Grande Valley,” said Texas Agriculture Commissioner Sid Miller in a statement. The parasitic worm threatens cattle, horses, sheep, goats, wildlife, pets, and even humans. In the past year, Mexico has reported an increase in animal and human cases. 
• The South Carolina Department of Public Health (DPH) has confirmed a second measles case in a Saluda County adult, which is related to the other case in the county reported April 17. These cases are not related to the Upstate outbreak that ended last month after 997 cases. “The first case was the result of international travel, and the second case was a known exposure of that case who had been in quarantine since April 17. No public exposures from this second case occurred. The individual’s vaccination history is unknown,” officials said. There are currently 39 people in quarantine through May 9. The second case-patient was diagnosed while in quarantine.