scholarly journals Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

2021 ◽  
pp. 1-8
Author(s):  
Katie J. Suda ◽  
Gosia S. Clore ◽  
Charlesnika T. Evans ◽  
Heather Schacht Reisinger ◽  
Ibuola Kale ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pathways ◽  
Statistical Significance ◽  
Implementation Strategies ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Approval ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
Advanced Generation

Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

scholarly journals 2092. Acceptability and Effectiveness of Implementation Strategies on Fluoroquinolone (FQ) Prescribing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S707-S707
Author(s):  
Katie J Suda ◽  
Gosia Clore ◽  
Charlesnika T Evans ◽  
Heather Reisinger ◽  
Ibuola Kale ◽  
...  
Keyword(s):  
Clinical Pathways ◽  
Implementation Strategies ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Fourth Generation ◽  
Antibiotic Prescribing ◽  
Simple Linear Regression ◽  
Prior Approval ◽  
Days Of Therapy ◽  
Local Use

Abstract Background The Food and Drug Administration (FDA) has issued multiple FQ safety warnings and recommends prescribing FQ only where alternatives are not available. We sought to assess the effectiveness and acceptability of differing implementation strategies on inpatient FQ prescribing. Methods Antimicrobial stewardship champions at 15 PBRN sites completed a survey in April 2018 regarding local use and acceptability of differing strategies to improve FQ prescribing. Sites with audit and feedback (PAF) and/or prior approval (PA) were compared with sites without these strategies. Antibiotic days of therapy (DOT) per 1000 days-present (DP) were extracted from the VA Corporate Data Warehouse for 2017–2018. Independent t-tests, contingency tables and simple linear regression were applied. Results 60% of sites had PAF or PA implemented for FQ. When compared with sites with no strategies in place (64.2 ± 34.4 DOT/DP), mean FQ prescribing rates were lower for sites that employed PAF/PA (35.5 ± 9.8; P = 0.03) and decreased over the 2-year period (P < 0.001 for trend by month). This decrease occurred without an increase in third/fourth-generation cephalosporins for the PAF/PA group (83.5 ± 18.8; P = 0.1 for trend), but increased for sites with no strategies in place (93.6 ± 55.2; P < 0.01 for trend). However, total antibiotic prescribing rates were not different for sites with PAF/PA (561.7 ± 77.8) or without strategies (644.1 ± 157.7; P = 0.2) and did not change over time (p> 0.2). Sites with PAF/PA that reported FQ implementation strategies were “completely” accepted had lower FQ rates than where it was moderately accepted (34.2 ± 5.7 vs. 48.7 ± 4.5; P < 0.01). The PBRN sites perceived that clinical pathways/local guidelines (93% of 15 sites), PA (93%), and order forms (80%) “would” or “may” be effective in improving FQ use. While most sites (73%) indicated that requiring infectious disease consults “would” or “may” be effective in improving FQ use, 87% perceived implementation to be difficult. Conclusion PAF and PA implementation strategies focused on FQ were associated with lower FQ prescribing rates, but not overall antibiotic use, indicating class substitution. This may indicate increased acceptability of implementation strategies and/or sensitivity to the FDA warnings. Disclosures All authors: No reported disclosures.

scholarly journals 71. Impact of Prospective Audit and Feedback on Fluoroquinolone Use: A Large Academic Medical Center Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Julio C Simon ◽  
Ana Vega
Keyword(s):  
Antimicrobial Stewardship ◽  
Statistical Significance ◽  
Academic Medical Center ◽  
Qt Prolongation ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Prospective Audit ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Abstract Background Fluoroquinolones are an effective class of antimicrobials; however, their use is not without consequence. Recent warnings have resulted in the FDA recommending to reserve this class for infections lacking alternative options. Antimicrobial stewardship significantly reduces targeted antimicrobial use, improves susceptibility patterns, decreases rates of Clostridium difficile infection (CDI), and reduces healthcare-associated costs. Literature on fluoroquinolone stewardship by antimicrobial stewardship programs report similar outcomes in addition to reductions in rates of extended-spectrum beta-lactamase (ESBL)-producing and methicillin-resistant S. aureus (MRSA) infection. Methods This study was a retrospective cohort study of adult patients receiving at least 3 days of a fluoroquinolone for an indication of pneumonia or urinary tract infection. Retrospective orders were assessed for prescribing patterns, duration of therapy, and antibiotic choice by indication. The primary outcome was reduction of fluoroquinolone consumption as a result of a prospective audit and feedback intervention, determined with days of therapy (DOT) and DOT per 1000 patient days. Secondary outcomes included hospital length-of-stay (LOS), 3-month post-exposure incidence of CDI, ESBL and MRSA infections, percentage of interventions accepted, and QT prolongation events. Mann-Whitney U was used to determine statistical significance for DOT and LOS, unpaired student t-test was used for DOT per 1000 patient days. Results 333 patients were reviewed. Fluoroquinolone median days-of-therapy (DOT) was significantly reduced in the intervention phase (7 vs. 4 days, P &lt; 0.001). Median LOS was 8 days for the cohort and did not differ between groups. After adjusting for identifiable alternative causes, no difference in QT prolongation, CDI or ESBL infection was observed. However, these results were limited by lack of diagnostic testing for QT prolongation and inability to assess for other contributing factors related to infection control. Conclusion Antimicrobial stewardship is an effective intervention to reduce fluoroquinolone use. An increased LOS was not observed despite patients switching to parenteral therapies. More data is needed to assess differences related to adverse events. Disclosures All Authors: No reported disclosures

scholarly journals 157. A Multidisciplinary Approach to Carbapenem Stewardship at a Large Community Hospital in Brooklyn, New York

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S88-S88
Author(s):  
Samuel Simon ◽  
Rosanna Li ◽  
Yu Shia Lin ◽  
Suri Mayer ◽  
Edward Chapnick ◽  
...  
Keyword(s):  
New York ◽  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Chi Square ◽  
Carbapenem Resistant ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Abstract Background Carbapenem-resistant gram-negative organisms are a continuously mounting threat, underscoring the need for effective antimicrobial stewardship interventions to improve the use of carbapenems. We sought to implement several multidisciplinary antimicrobial stewardship interventions beginning in January 2019 in an effort to reduce unnecessary meropenem use and the incidence of carbapenem-resistant gram-negatives. Methods Prospective audit and feedback was utilized daily in combination with weekly stewardship rounds between an Infectious Diseases pharmacist and physician in the Intensive Care Units. A second Infectious Diseases physician attended weekly interdisciplinary rounds on meropenem high-use units. Meropenem Days of Therapy (DOT) per 1,000 patient days and the incidence of meropenem resistant Pseudomonas aeruginosa and Klebsiella pneumoniae were compared by the chi-square test of proportions. Results Between 2018 and 2019 the institution’s meropenem DOT per 1,000 patient days decreased 33%, from 57 to 38 days per 1,000 patient days (difference, 19 days per 1,000 patient days; p&lt; 0.001). In the hospital antibiogram, the meropenem susceptibility of Pseudomonas aeruginosa over the same time period increased from 71% to 77% of isolates (difference, 6%; p = 0.009). A non-significant decrease in the susceptibility of meropenem to Klebsiella pneumoniae was also observed from 92 to 90% (difference, 2%: p = 0.1658). Conclusion These data support the need for antimicrobial stewardship efforts targeting broad-spectrum antimicrobials such as meropenem. In the setting of a sustained decrease in meropenem use over 12 months, we observed a significant improvement in the percent susceptibility rate of Pseudomonas aeruginosa to meropenem for the first time in five years. Disclosures All Authors: No reported disclosures

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

2018 ◽  
Vol 39 (8) ◽  
pp. 941-946 ◽  
Author(s):  
Bradley J. Langford ◽  
Julie Hui-Chih Wu ◽  
Kevin A. Brown ◽  
Xuesong Wang ◽  
Valerie Leung ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Defined Daily Doses ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

scholarly journals 1059. Impact of a Syndrome-Based Antimicrobial Stewardship Intervention on Anti-Pseudomonal β-Lactam Use, C. difficile Rates and Cost in an Urban Community Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S374-S375
Author(s):  
Alfredo J Mena Lora ◽  
Martin Cortez ◽  
Ella Li ◽  
Lawrence Sanchez ◽  
Rochelle Bello ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Treatment Guidelines ◽  
Urban Community ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Days Of Therapy ◽  
Before And After ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background The use of anti-Pseudomonal β-lactam (APBL) agents has significantly increased in the past decade, carrying higher costs and contributing to antimicrobial pressure. Antimicrobial stewardship (ASP) can promote evidence-based antimicrobial selection and mitigate excess APBL use. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback (PAF) at an urban community hospital. The goal of this study is to assess the impact of syndrome-based PAF on APBL use, C. difficile rates and cost. Methods ASP with all CDC core elements was implemented at a 151-bed community hospital in October 2017. Syndrome-based guidelines and PAF was established and overseen via direct communication with an ID physician. Days of therapy (DOT), cost and C. difficile rates were assessed 12 months before and after ASP. DOT for APBL and non-APBL utilization was tabulated by unit and paired t-test performed. Results Most cases reviewed by PAF (51%) were represented in our syndrome-based treatment guidelines (Figure 1). Soft tissue (33%) and intra-abdominal (24%) infections were the most common syndromes. Change to guideline was the most common PAF intervention (62%) followed by de-escalation (30%). At 12 months, total DOT/1,000 increased (392.5 vs. 404) while the proportion of parenteral antimicrobials used decreased (71% vs. 65%). Antibiotic expenditures decreased by 23%, with a reduction in APBL of 20% and non-APBL of 10% (Table 1). Statistically significant reductions APBL use in non-ICU settings (P = 0.0139) and statistically significant increases in non-APBL in ICU settings occurred (P = 0.0001) (Figure 2 and 3). C difficile rates decreased from 21% (3.27 vs. 2.56). Conclusion Syndrome-based PAF was successfully implemented. A reduction in APBL use was seen in non-ICU settings, where evidence-based de-escalation may be more feasible. APBL use remained high in the ICU but was guideline consistent. A rise in non-APBL use also occurred. Certain critical illness syndromes warrant APBLs, but PAF may promote culture-directed and syndrome-specific treatments. ASP increased guideline-based therapy and contributed to decreased broad-spectrum antimicrobial use, antimicrobial expenditures and C difficile rates. Syndrome based PAF can be successfully implemented in community settings. Disclosures All authors: No reported disclosures.

scholarly journals 105. Fluoroquinolone Stewardship at a Community Health-System: A Decade in Review

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S167-S167
Author(s):  
Matthew Song ◽  
Ashley Wilde ◽  
Ashley Wilde ◽  
Sarah E Moore ◽  
Brian C Bohn ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Antimicrobial Stewardship Program ◽  
Provider Education ◽  
E Coli ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Adult Inpatient ◽  
Prospective Audit And Feedback ◽  
Adult Hospital

Abstract Background Fluoroquinolone stewardship is a common target for antimicrobial stewardship programs seeking to maintain or improve fluoroquinolone susceptibility rates. Additional benefits include reducing C. difficile infection rates, drug toxicities, and resistance to other antimicrobials as fluoroquinolones can co-select for resistance. The Norton Healthcare antimicrobial stewardship program was founded in 2011 and provides services at 4 adult hospitals with ~1600 beds. Main fluoroquinolone stewardship activities have included provider education, prospective audit and feedback, and guideline and order-set development. The purpose of this study was to describe the resistance and usage rates of fluoroquinolones over time. Methods This was a descriptive study examining individual adult hospital antibiograms from 2010 to 2020. Levofloxacin susceptibility rates to E. coli and P. aeruginosa were collated from annual antibiograms between 2010 and 2020 for outpatients and each adult hospital. Adult hospital resistance rates were aggregated and weighted accordingly to number of isolates per hospital per year. Additionally, levofloxacin and ciprofloxacin inpatient days of therapy (DOT) was collected since 2016 when DOT was first readily retrievable and was normalized per 1000 patient days to compare between different time points. Results Outpatient levofloxacin likelihood of activity against P. aeruginosa improved from 81% to 91%. Outpatient levofloxacin likelihood of activity against E. coli remained stable between 84 – 86% (Figure 1). Adult inpatient fluoroquinolone usage decreased by approximately 75% from 83.5 to 21.37 DOT/1000 patient days since 2016 (Figure 2). Adult inpatient levofloxacin likelihood of activity against P. aeruginosa improved from 53% to 83%. Adult inpatient levofloxacin likelihood of activity against E. coli improved from 65% to 75% (Figure 3). Conclusion The Norton Healthcare antimicrobial stewardship program has been effective in reducing unnecessary fluoroquinolone usage and improving inpatient fluoroquinolone susceptibility rates. Future studies should examine opportunities to translate successes to the outpatient phase of care. Disclosures Ashley Wilde, PharmD, BCPS-AQ ID, Nothing to disclose Paul S. Schulz, MD, Gilead (Consultant, Speaker’s Bureau)Merck (Consultant, Speaker’s Bureau)

scholarly journals 1141. Implementation of a Pediatric Handshake Antimicrobial Stewardship Program to Improve Antimicrobial Utilization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S406-S406
Author(s):  
Amanda P Hughes ◽  
Maya Beganovic ◽  
Ronda Oram ◽  
Sarah Wieczorkiewicz ◽  
Anthony Chiang
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Acceptance Rates ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Antimicrobial stewardship (AMS) programs emerged in response to rising rates of resistance and adverse effects associated with inappropriate antimicrobial utilization. Optimal metrics and strategies (e.g., preauthorization, prospective audit and feedback) for AMS remain to be elucidated. This study evaluated the impact of a multidisciplinary, rounding-based AMS strategy (i.e., Handshake Stewardship) on antimicrobial utilization and prescribing practices at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a community, teaching children’s hospital. All pediatric and neonatal inpatients with active antimicrobial orders between July 2018 and March 2019 were included in the study, and endpoints were compared with data from July 2017- March 2018. Antimicrobial courses were prospectively audited by a multidisciplinary AMS team, and feedback was provided to the primary teams during Handshake Stewardship rounds. The primary endpoint was a number of interventions made and the corresponding acceptance rates. The secondary endpoint was days of therapy (DOT) per 1000 patient-days. Descriptive statistics were performed on all continuous and categorical data as appropriate. Results Of 2238 antimicrobial courses reviewed, 710 (32%) required intervention, and 86% of the interventions made were accepted. The top 3 indications evaluated were respiratory (n = 522, 23%), sepsis/bacteremia (n = 351, 16%), and surgical prophylaxis (n = 266, 12%). Of the respiratory courses reviewed, there were 228 opportunities for antimicrobial optimization. The most common interventions were: bug-drug optimization (n = 208, 29%), discontinuation of anti-infective (n = 136, 19%), and dose optimization (n = 120, 17%). No significant difference was observed for overall, ceftriaxone, meropenem, and vancomycin DOT pre- and post-implementation of Handshake Stewardship. However, a statistically significant reduction in DOTs was observed for piperacillin–tazobactam (15.2 vs. 7.4, P = 0.004) and a nonsignificant reduction in meropenem (9.5 vs. 6.2). Conclusion Rounding-based, Handshake AMS was associated with overall high intervention acceptance rates and a reduction in commonly utilized broad-spectrum antimicrobials. Disclosures All authors: No reported disclosures.

scholarly journals 223. Difference in Carbapenem Use by ASP Intervention in Japanese Healthcare Facilities

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S112-S113
Author(s):  
Mio Endo ◽  
Shinya Tsuzuki ◽  
Yusuke Asai ◽  
Taichi Tajima ◽  
Nobuaki Matsunaga ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Median Number ◽  
Audit And Feedback ◽  
Average Hospital ◽  
Healthcare Facilities ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Difference ◽  
Prospective Audit And Feedback

Abstract Background Antimicrobial stewardship program (ASP) interventions have been reported to reduce unnecessary antimicrobial use (AMU). In this study, we investigated the difference in the use of carbapenems by ASP intervention in Japanese healthcare facilities. Methods Data on two components of AMU and ASP registered in Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) from January to December 2019, were used. Facilities with an infection control team in addition to an antimicrobial stewardship team responsible for the proper use of antimicrobial agents were included in the study. AMU data (such as DOT [Days of Therapy / 100 patient days]) are entered semi-automatically from medical fee statement (receipt) file at each facility. ASP intervention is divided into four categories 1) pre-authorization, 2) prospective audit and feedback (PAF), 3) PAF and required notification (RN), 4) RN. The Kruskal-Wallis test is performed to see overall difference and the Dunn test with the Bonferroni correction is done for each pair of categories. Results A total of 114 hospitals were included in the analysis. The median number of beds at participating facilities were 430 [IQR: 281–602], the median average hospital stay was 13.0 days [IQR: 11.4–15.2] and total number of inpatients per month was 10087 [6247–14536]. PAF and RN were the most common ASP interventions for carbapenems (62.5%), followed by RN (33.6%). The median DOT [IQR] of participating facilities were 2.1 [1.2–3.1] and 1) 0.7 [0.2–1.1], 2) 2.7 [2.1–3.4], 3) 2.1 [1.4–3.1] and 4) 2.0 [1.2–3.5] by ASP categories. There are significant differences between 1) and 2), 1) and 3), and 1) and 4) (p=0.014, p&lt; 0.01 and p&lt; 0.01, respectively) while the differences between 2) and 3), 2) and 4), and 3) and 4) are not significant (p=1.00). Table 1. Summary statistics of healthcare facilities by ASP Interventions Figure 1. DOT by ASP Interventions Conclusion Only 3.5% of ASP interventions belong to 1) pre-authorization category and this might be due to the complexity of registration process. This category was found to have the lowest DOT among all ASP interventions in Japanese healthcare facilities. The variances of DOT were especially large in categories 3) and 4), and more detailed analyses would be necessary to evaluate their efficacies accurately. Disclosures All Authors: No reported disclosures

Audit and Feedback to Reduce Broad-Spectrum Antibiotic Use among Intensive Care Unit Patients A Controlled Interrupted Time Series Analysis

2012 ◽  
Vol 33 (4) ◽  
pp. 354-361 ◽  
Author(s):  
Marion Elligsen ◽  
Sandra A. N. Walker ◽  
Ruxandra Pinto ◽  
Andrew Simor ◽  
Samira Mubareka ◽  
...  
Keyword(s):  
Time Series ◽  
Critical Care ◽  
Intensive Care ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Broad Spectrum Antibiotic ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback

Objective.We aimed to rigorously evaluate the impact of prospective audit and feedback on broad-spectrum antimicrobial use among critical care patients.Design.Prospective, controlled interrupted time series.SettingSingle tertiary care center with 3 intensive care units.Patients and Interventions.A formal review of all critical care patients on their third or tenth day of broad-spectrum antibiotic therapy was conducted, and suggestions for antimicrobial optimization were communicated to the critical care team.Outcomes.The primary outcome was broad-spectrum antibiotic use (days of therapy per 1000 patient-days; secondary outcomes included overall antibiotic use, gram-negative bacterial susceptibility, nosocomial Clostridium difficile infections, length of stay, and mortality.Results.The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period (P < .0001); time series modeling confirmed an immediate decrease (± standard error) of 119 ± 37.9 days of therapy per 1,000 patient-days (P = .0054). In contrast, no changes were identified in the use of broad-spectrum antibiotics in the control group (nonintervention medical and surgical wards) or in the use of control medications in critical care (stress ulcer prophylaxis). The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units, whereas the incidence increased from 87 to 116 cases in the control wards (P = .04). Overall gram-negative susceptibility to meropenem increased in the critical care units. Intensive care unit length of stay and mortality did not change.Conclusions.Institution of a formal prospective audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care.

scholarly journals 83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Casey J Dempsey ◽  
Natasha Weiner ◽  
Michele Riccardi ◽  
Kristin Linder
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p &lt; 0.001), ciprofloxacin (23.22 vs. 9.97; p &lt; 0.001), levofloxacin (11.2 vs. 5.07; p &lt; 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p &lt; 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p &lt; 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p &lt; 0.001), levofloxacin ($2,168 vs. $672; p &lt; 0.001), ciprofloxacin ($6,700 vs. $1,954; p &lt; 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p &lt; 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

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