Effects of a nudge-based antimicrobial stewardship program in a pediatric primary emergency medical center

2021 ◽  
Author(s):  
Ayumi Shishido ◽  
Shogo Otake ◽  
Makoto Kimura ◽  
Shinya Tsuzuki ◽  
Akiko Fukuda ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Antimicrobial Stewardship Program ◽  
Emergency Medical ◽  
Stewardship Program

scholarly journals 1064. Antimicrobial Stewardship Program at a Large Academic Medical Center, Impact Over 12 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S376-S377
Author(s):  
Susan E Kline ◽  
Kimberly Boeser ◽  
Jeana Houseman ◽  
Samantha Saunders ◽  
Shawnda Johnson ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Downward Trend ◽  
Full Time ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Hospital Acquired

Abstract Background The University of Minnesota Medical Center (UMMC) is a tertiary care facility, which has had a comprehensive antimicrobial stewardship program (ASP) for 12 years. Methods The antimicrobial stewardship team is comprised of a full-time PharmD and ID staff physicians. Recommendations are placed in the electronic medical record as a progress note. Verbal recommendations may also be made. Results There was a downward trend in Hospital-acquired (HA) C. difficile diarrhea from 2007 to 2014 from 1.2 to 0.5/1000 patient-days (pt day). Rates appear stable from 2014 to 2019 with adjustment for change to NHSN lab-based CDI surveillance (Figure 1). From 2009 to 2019 a decrease was seen in VRE hospital-acquired infections (HAI) from 0.53 to 0.21/1,000 patient-days and in MRSA HAIs from 0.2 to 0.14/1,000 patient-days. Newly acquired ESBL HAIs have remained relatively stable from 2009 to 2019 at 0.09 to 0.05/1,000 patient-days. CRE HAIs are low but stable rates at 0.02/1,000 patient-days (Figure 2). We track antimicrobial utilization for internal and national reporting (starting in July 2017). A SAAR for all Antibacterial agents (ICUs, wards, and oncology units) of 1.33 in 2018. Our top four agents average DOT; piperacillin/tazobactam (66.81), cefepime (34.40), oral levofloxacin (23.56) and intravenous meropenem (21.49). We demonstrate lower average DOT for our restricted antimicrobials (206.21) as compared with our nonrestricted antimicrobials (236.74) (Figure 3). Cost savings continued from year to year. After adjusting for inflation annually, our expected costs ($84.08) compared with actual costs ($40.12 ytd 2019), demonstrates effective cost management of antimicrobial agents. (Figure 4) Conclusion We observed a decrease in HAIs VRE and C. difficile infections after 3 years of operation, and MRSA after 5 years. This downward trend has continued. ESBL HAIs remain relatively stable and CRE are stable at low rates but remain emerging HAIs of concern. We are now focusing efforts on limiting unneeded fluoroquinolone and carbapenem use. We continue to analyze our SAAR data and internal DOT data to identify areas of opportunity to improve antimicrobial use. The ASP outcomes have continued to cost justify ongoing efforts. The effects of the program and the Infection Prevention Department appear to be synergistic. Disclosures All authors: No reported disclosures.

scholarly journals 1029. Clinical and economic outcomes of a newly implemented daptomycin dosing policy in a four-hospital health system

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S362-S362
Author(s):  
Meredith Todd ◽  
Kelci Jones ◽  
Sharon Hill
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Pharmacokinetic Data ◽  
Antimicrobial Stewardship Program ◽  
Obese Patients ◽  
Pharmacy Department ◽  
Stewardship Program ◽  
Increased Risk ◽  
Dosing Strategy ◽  
Drug Waste

Abstract Background In light of recently published clinical and pharmacokinetic data regarding the use of daptomycin in obese patients, the Charleston Area Medical Center (CAMC) Antimicrobial Stewardship Program implemented an adjusted body weight dosing strategy for obese patients. Along with this new dosing strategy, an effort to reduce drug waste was also implemented by restricting the timing of routinely scheduled daptomycin doses for inpatients. This study aims to determine the clinical outcomes for patients receiving daptomycin both before and after this policy change. Secondary objectives include assessing creatinine phosphokinase (CK) levels in the study participants, defining the risk of CK elevation with the coadministration of HMG Co-A reductase inhibitors and daptomycin, and assessing any reduction in drug waste for the pharmacy department. Methods This study is a single-center, one-group pretest-posttest, quasi-experimental study evaluating the implementation of a two-part daptomycin dosing policy. The pretest group included all patients meeting inclusion and exclusion criteria that received daptomycin at CAMC from September 1 - November 30, 2017. The new daptomycin dosing policy was implemented on September 1, 2018. The posttest group included all patients meeting the stated criteria that received daptomycin from September 1 - November 30, 2018. Results A total of 118 patients were included in this study. There were 5 (7.7%) treatment failures in the pretest group and 3 (5.7%) in the posttest group (P = 0.7). Of the patients with CK levels monitored, 6 (33%) were found to have significant elevations in the pretest group and 4 (40%) were found in the posttest group (P = 0.6). There was no difference observed in the risk of CK elevation with daptomycin administration in the presence of an HMG-CoA reductase inhibitor. For the two time periods reviewed, the pharmacy department purchased fewer vials of daptomycin in the posttest group. Conclusion Patients at CAMC receiving daptomycin after implementation of a new dosing policy did not experience an increased risk of treatment failure. The Antimicrobial Stewardship Program will continue to monitor patients receiving daptomycin therapy at CAMC. Disclosures All authors: No reported disclosures.

Antimicrobial Stewardship at a Large Tertiary Care Academic Medical Center: Cost Analysis Before, During, and After a 7-Year Program

2012 ◽  
Vol 33 (4) ◽  
pp. 338-345 ◽  
Author(s):  
Harold C. Standiford ◽  
Shannon Chan ◽  
Megan Tripoli ◽  
Elizabeth Weekes ◽  
Graeme N. Forrest
Keyword(s):  
Infectious Diseases ◽  
Cost Analysis ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Fiscal Year ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Large Tertiary Care

Background.An antimicrobial stewardship program was fully implemented at the University of Maryland Medical Center in July 2001 (beginning of fiscal year [FY] 2002). Essential to the program was an antimicrobial monitoring team (AMT) consisting of an infectious diseases-trained clinical pharmacist and a part-time infectious diseases physician that provided real-time monitoring of antimicrobial orders and active intervention and education when necessary. The program continued for 7 years and was terminated in order to use the resources to increase infectious diseases consults throughout the medical center as an alternative mode of stewardship.Design.A descriptive cost analysis before, during, and after the program.Patients/Setting.A large tertiary care teaching medical center.Methods.Monitoring the utilization (dispensing) costs of the antimicrobial agents quarterly for each FY.Results.The utilization costs decreased from $44,181 per 1,000 patient-days at baseline prior to the full implementation of the program (FY 2001) to $23,933 (a 45.8% decrease) by the end of the program (FY 2008). There was a reduction of approximately $3 million within the first 3 years, much of which was the result of a decrease in the use of antifungal agents in the cancer center. After the program was discontinued at the end of FY 2008, antimicrobial costs increased from $23,933 to $31,653 per 1,000 patient-days, a 32.3% increase within 2 years that is equivalent to a $2 million increase for the medical center, mostly in the antibacterial category.Conclusions.The antimicrobial stewardship program, using an antimicrobial monitoring team, was extremely cost effective over this 7-year period.

scholarly journals Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

2019 ◽  
Vol 66 (1) ◽  
pp. 29-33
Author(s):  
Priyam Mithawala ◽  
Edo-abasi McGee
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Control Group ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Significant Difference ◽  
The Impact

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

scholarly journals Impact of an Antimicrobial Stewardship Program Led OPAT Program on Clinical Complications and Frequency of Hospital Readmissions

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S334-S335
Author(s):  
J Andrew Carr ◽  
John W Baddley ◽  
Sonya Heath ◽  
Rachael A Lee ◽  
Todd P McCarty
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Home Health ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Hospital Days

Abstract Background Treatment of serious bacterial infections with Outpatient Parenteral Antibiotic Therapy (OPAT) has provided patients (patients) the opportunity to complete treatment safely and effectively, while avoiding complications, and prolonged hospitalization. Despite the benefits, considerable risks with drug-related and central venous catheter (CVC)-related complications exist. We sought to improve clinical outcomes of our program by implementing intensive monitoring in partnership with our antimicrobial stewardship program (ASP) with a goal of decreasing the frequency of complications as well as hospital readmission rates and lengths of stay (LOS). Methods A retrospective study was conducted including all patients discharged from the Birmingham VA Medical Center on OPAT from January 1, 2015 to December 31, 2016. The start date coincides with ASP development of a physician and pharmacist led OPAT program, working closely with home health agencies. Data collection included baseline demographics, antibiotic indication, antibiotic therapy received, and laboratory monitoring. Clinical outcomes included frequency and types of drug-related complications, CVC complications, hospital admission rate due to complications, and hospital days avoided. Results In the study period, 299 patients were discharged on OPAT. They were 96.9% male, and the average age was 64 (Table 1). The average number of hospital days avoided was 32.1. The most common indication was osteomyelitis (Table 1). There were 82 complications in 78 (26%) patients, almost half were acute kidney injury, defined as a rise in serum creatinine requiring a change in antibiotic dosing (Table 2). These led to 25 hospitalizations (32% of patients with complications, 8.3% overall) with another 5 patients being hospitalized for unrelated reasons. Conclusion Our medical center instituted an ASP led practice of closely monitoring and directing care with the local home health agencies due to concerns about patient safety. In doing so, we have realized a low rate of complications and an ability to manage the majority while remaining as an outpatient, with the exceptions of CVC-related complications and encephalopathy. Our data supports the center’s efforts and choice to dedicate resources to improving this increasingly popular treatment. Disclosures All authors: No reported disclosures.

scholarly journals Impact of an Antimicrobial Stewardship Program at a Large Academic Medical Center, a Decade of Experience

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S264-S265
Author(s):  
Susan Kline ◽  
Kimberly Boeser ◽  
Samantha Saunders ◽  
Kari Gand ◽  
Jeana Houseman ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Academic Medical
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