scholarly journals 69. Impact of antimicrobial stewardship interventions on post-elective caesarean antibiotic prophylaxis and surgical site infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S53-S53
Author(s):  
Xue Fen Valerie Seah
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Antimicrobial Stewardship ◽  
Phase 1 ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Phase 2 ◽  
Oral Antibiotics ◽  
Post Intervention ◽  
Intervention Phase

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use. In a subgroup of those without surgical site infection (SSI) risk factors, 30-day SSI rates was compared in those who received post-eLSCS oral antibiotics vs. those without. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was discouraged in those without SSI risk factors (e.g. obesity). This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 4 months (phase 2). Results A total of 894 women were reviewed. There were 244 women in the pre-intervention phase, 274 in post-intervention phase 1 and 376 in phase 2. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), compared to 54% (148) in phase 1 and 49% (180) in phase 2 (p< 0.001). There were 560 women without SSI risk factors. Of these, only 4 of 301 (1.3%) who received oral antibiotics, and 3 of 259 (1.2%) without oral antibiotics developed post-op SSI (p=1.000). Conclusion ASP can reduce post-eLSCS antibiotic prophylaxis. In those without SSI risk factors, use of post-eLSCS oral antibiotics did not impact SSI rates. Disclosures All Authors: No reported disclosures

scholarly journals 137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S182-S182
Author(s):  
Xue Fen Valerie Seah ◽  
Yue Ling Rina Ong ◽  
Wei Ming Cedric Poh ◽  
Shahul Hameed Mohamed Siraj ◽  
Kai-Qian Kam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Patient Outcomes ◽  
Phase 1 ◽  
Surgical Site Infections ◽  
Phase 2 ◽  
Oral Antibiotics ◽  
Post Intervention ◽  
Phase 3 ◽  
The Impact

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

scholarly journals 63. Impact of Infectious Disease Fellow-Driven Antimicrobial Stewardship Interventions on Inpatient Fluoroquinolone Use

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S150-S150
Author(s):  
Carlos M Nunez ◽  
Arun Mattappallil ◽  
Katie A McCrink ◽  
Debbie Rybak ◽  
Basil Taha ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Phase 1 ◽  
Clinical Indication ◽  
Phase 2 ◽  
Intervention Phase ◽  
Stewardship Program ◽  
Wide Range ◽  
The Impact

Abstract Background Fluoroquinolone (FQ) antibiotics are frequently used in hospitalized patients to treat a wide range of infections but are often misused and implicated in antibiotic-associated adverse events. The purpose of this study is to evaluate the impact of Infectious Disease fellow (IDF)-driven antimicrobial stewardship program (ASP) interventions on inpatient FQ use. Methods This is a retrospective study of all admitted patients who received a FQ for greater than 48 hours from 01/01/2019 -12/31/2020 in an urban academic center. “Phase 1” (pre-intervention phase) covered 01/1/2019- 03/31/2019. “Phase 2” (intervention phase) covered 03/03/2020- 12/23/2020. In “Phase 2”, our ASP reviewed FQ use 2-3 days per week and an IDF provided feedback interventions that averaged 30-60 minutes of IDF time spent per day. We categorized FQ use as either: “appropriate”, “appropriate but not preferred”, or “inappropriate”, as determined by local clinical guidelines and ASP team opinion. We compared FQ use in both phases, indications for FQ use, and new Clostridioides difficile infections (CDI). Results A total of 386 patients are included (76 in “Phase 1”and 310 in “Phase 2”). Patient characteristics are similar (Table 1). Overall, 63 % of FQ use was empiric, and 50% FQ use was deemed “appropriate”, 28% “appropriate but not preferred”, and 22% “inappropriate”. In “Phase 2”, 126 interventions were conducted, with 86% of these accepted. Appropriate FQ use increased significantly in “Phase 2” vs. “Phase 1” (53.5% vs 35.5%, p = 0.008), with decrease in mean days of FQ use (4.38 days vs 5.87 days, p =.021). Table 2 shows “appropriate” FQ use by clinical indication. New CDIs occurred more in “Phase 1” vs. “Phase 2” (6.6% vs 0.6%, p=.001). Conclusion An IDF-driven ASP intervention has a positive impact on appropriate inpatient use of FQs in our hospital. This highlights a promising ASP model which not only improves appropriate use of FQ, but also offers an opportunity for IDF mentorship and use of available resources to promote ASPs. Disclosures Katie A. McCrink, PharmD, ViiV Healthcare (Employee)

scholarly journals 131. A Pharmacist Led Antimicrobial Stewardship Pilot at Discharge Improves Outpatient Antibiotic Utilization

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S178-S178
Author(s):  
Kayla Hiryak ◽  
Geena Kludjian ◽  
Jason C Gallagher ◽  
Jason C Gallagher ◽  
Marissa Cavaretta
Keyword(s):  
Antimicrobial Stewardship ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Acceptance Rate ◽  
Transitions Of Care ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Research Support ◽  
The Impact

Abstract Background The impact of antimicrobial stewardship programs has been well observed in institutional settings; however, patients complete over one-third of their antibiotic course after discharge. This creates a gap in stewardship efforts at transitions of care. We studied whether pharmacist review of antibiotic prescriptions at discharge would improve outpatient antibiotic prescribing. Methods This was a pilot project of patients in medicine wards of an academic medical center who were discharged on oral antibiotics between February and May 2021. Patients who were pregnant, <18 YO, had COVID-19, or leaving against medical advice were excluded from evaluation. For the pilot, a verification queue was created in the electronic health record (EHR) system where orders for discharge antibiotics were reviewed by investigator pharmacists before prescriptions were electronically sent to outpatient pharmacies. During the pilot, prescriptions were reviewed Monday-Friday afternoons from 12pm-4pm. Data was collected on incidence, type, and acceptance rate of pharmacist interventions, and a cost savings analysis was conducted with values calculated by the EHR system. Results There were 149 patients included with oral antibiotic prescriptions reviewed during the time frame. Of those patients, 48 (32.2%) had at least one prescription that was intervened on by a pharmacist. A total of 55 interventions were made with an acceptance rate of 76%. The median time for pharmacist review was 10 minutes (IQR 5-15). Patients who received infectious diseases (ID) consultation during admission required less intervention than patients without expert consultation but did not reach significance (8/35 and 47/114 respectively, p=0.07). The total cost savings associated with all interventions was &20,743.00. Table 1. Interventions Conclusion Direct pharmacist review and intervention at discharge improved the prescribing of oral antibiotics within our institution during this pilot. Considering that this was conducted part-time in a subset of hospitalized patients during a limited time period, significant cost savings are possible with greater implementation. Disclosures Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Consultant, Speaker’s Bureau)Merck (Consultant, Grant/Research Support, Speaker’s Bureau)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant) Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Astellas (Individual(s) Involved: Self): Speakers’ bureau; Merck (Individual(s) Involved: Self): Consultant, Grant/Research Support; Nabriva: Consultant; Qpex (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant Marissa Cavaretta, PharmD, Merck (Grant/Research Support)

Compliance with Local Guidelines for Antibiotic Prophylaxis in Surgery

2004 ◽  
Vol 25 (4) ◽  
pp. 308-312 ◽  
Author(s):  
Montserrat Pons-Busom ◽  
Margarita Aguas-Compaired ◽  
Jordi Delás ◽  
Begoña Eguileor-Partearroyo
Keyword(s):  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Phase 1 ◽  
Antibiotic Prescribing ◽  
Phase 2 ◽  
Cross Sectional ◽  
Computer Based ◽  
High Degree ◽  
Local Antibiotic ◽  
Local Protocol

AbstractObjectives:To describe the development and implementation of a local protocol for antibiotic prophylaxis in surgery and to assess compliance with these guidelines using a computer-based system.Design:One 5-week prospective period (phase 1) followed by three 1-week, cross-sectional assessments (phases 2, 3, and 4).Setting:Pharmacy of a 350-bed acute care teaching hospital in Barcelona, Spain.Methods:In phase 1, 395 forms for antibiotic prescribing delivered to the pharmacy were reviewed. Nonadherence was defined as the prescription of an antibiotic (or doses) different from what the protocol specified. In phases 2, 3, and 4, antibiotic prescribing forms for all elective procedures (630 patients) performed during 1-week periods were analyzed.Results:A total of 1,047 patients (mean age, 58.9 ± 17.3 years) were included. Cefazolin was administered in 41% of procedures. Overall compliance with antibiotic prescribing forms was 83.3%. There was a statistically significant increase in compliance with guidelines throughout the four phases of the study, from 80.3% in phase 1 to 87.8% in phase 4 (P < .042), as well as adherence to completing forms for surgical procedures, from 51% in phase 2 to 77.6% in phase 4 (P < .001). The main reason for non-adherence was that some procedures had not been included in the protocol in phase 2.Conclusion:Surgeons sensitized to the implementation of local antibiotic prophylaxis guidelines showed a high degree of compliance with them, using both the procedure established for antibiotic prescribing and the antimicrobials recommended for particular operations.

scholarly journals 1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S405-S405
Author(s):  
Sarah Primhak ◽  
Natasha Pool ◽  
Gayl Humphrey ◽  
Lesley Voss ◽  
Rachel H Webb ◽  
...  
Keyword(s):  
Decision Making ◽  
Antimicrobial Stewardship ◽  
Point Of Care ◽  
Smartphone Application ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Duration Of Treatment ◽  
Antibiotic Allergy ◽  
Alternative Agent ◽  
The Impact

Abstract Background When considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care. Methods Using local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms. Results The smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials. Conclusion Script for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis. Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed. Disclosures All authors: No reported disclosures.

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

scholarly journals Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

2017 ◽  
Vol 61 (9) ◽  
Author(s):  
P. B. Bookstaver ◽  
E. B. Nimmich ◽  
T. J. Smith ◽  
J. A. Justo ◽  
J. Kohn ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Phase 1 ◽  
Bloodstream Infections ◽  
Antimicrobial Stewardship Program ◽  
Phase 2 ◽  
Beta Lactams ◽  
Gram Negative ◽  
Stewardship Program ◽  
Tof Ms

ABSTRACT The use of rapid diagnostic tests (RDTs) enhances antimicrobial stewardship program (ASP) interventions in optimization of antimicrobial therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical antimicrobial therapy (EAT) and time to de-escalation of broad-spectrum antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; P = 0.02). Significant reductions in median time to de-escalation from combination antimicrobial therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period (P < 0.001 for all). The reduction in median time to de-escalation from combination therapy (1.0 versus 2.0 days; P = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; P = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.

scholarly journals Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative

2021 ◽  
Author(s):  
Marilyn Rantz ◽  
G. F. Petroski ◽  
L. L. Popejoy ◽  
A. A. Vogelsmeier ◽  
K. E. Canada ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Phase 1 ◽  
Quality Measures ◽  
The State ◽  
Full Time ◽  
Improve Quality ◽  
Phase 2 ◽  
Intervention Phase ◽  
Tract Infections

Abstract Objectives To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. Design A four group comparative analysis of longitudinal data from September 2013 thru December 2019. Setting NHs in the interventions of both Phases 1 (2012–2016) and 2 (2016–2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). Participants NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. Measurements Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. Results The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) outperformed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. Conclusion These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.

scholarly journals 1107. Impact of Routine Education and Data Feedback on the Durability of an Antimicrobial Stewardship Intervention for Outpatient Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S394-S394
Author(s):  
Jason Funaro ◽  
Rebekah W Moehring ◽  
Beiyu Liu ◽  
Hui-Jie Lee ◽  
Christina Sarubbi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 1 ◽  
Urgent Care ◽  
Phase 2 ◽  
Intervention Phase ◽  
Data Feedback ◽  
Specific Feedback ◽  
Initial Intervention ◽  
Tract Infections

Abstract Background Achieving lasting, sustainable effects in outpatient AS interventions has been a challenge for many programs. Our group observed an initial benefit of an outpatient AS intervention focused on diagnosis and management of urinary tract infections (UTIs). However, prescribing habits trended back toward baseline over time. This study aimed to evaluate the impact of routine education and comparative data feedback on the durability of an outpatient AS intervention for UTIs. Methods We conducted a prospective quasi-experimental study at one primary care (PC) and one urgent care (UC) clinic to evaluate the durability of an outpatient AS intervention implemented in August 2017 and November 2017, respectively. Clinicians who treated adult patients with a diagnosis of acute UTI at either clinic participated in the study. The initial intervention (phase 1) included development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines. Approximately 12 months after the initial intervention, routine education along with clinic- and comparative provider-specific feedback reports were emailed to clinicians at regular intervals (phase 2). The primary outcome was percent of encounters in which first- or second-line antibiotics were prescribed. Pre- and post-intervention phase and trend changes were assessed using an interrupted time-series approach. Results Data were collected on 792 and 3,720 UTI encounters at PC and UC, respectively. In the 12 months after the initial intervention, rates of guideline concordance were 73% at PC and 57% at UC (Figures 1 and 2). After routine data feedback was provided for approximately 7 months at PC and 5 months at UC, rates of guideline concordance remained relatively stable at 75% for PC and 61% at UC. An initial 37% relative reduction in fluoroquinolone (FQ) use was observed during phase 1 which was further reduced by an additional 18% during phase 2. Conclusion Routine provision of clinic-specific feedback and peer comparisons sustained rates of guideline-concordant prescribing at two outpatient clinics. This intervention required significant resources for data analysis and delivery, but it was successful in decreasing rates of FQ prescribing and maintaining clinician engagement. Disclosures All authors: No reported disclosures.

scholarly journals Patterns of Oral Antibiotic Use and Excess Duration at Hospital Discharge

2020 ◽  
Vol 41 (S1) ◽  
pp. s522-s523
Author(s):  
Corey Medler ◽  
Nicholas Mercuro ◽  
Helina Misikir ◽  
Nancy MacDonald ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Guideline Recommendation ◽  
Resistant Organism ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Cross Sectional ◽  
Tract Infections

Background: Antimicrobial stewardship (AMS) interventions have predominantly involved inpatient antimicrobial therapy. However, for many hospitalized patients, most antibiotic use occurs after discharge, and unnecessarily prolonged courses of therapy are common. Patient transition from hospitalization to discharge represents an important opportunity for AMS intervention. We describe patterns of antibiotic use selection and duration of therapy (DOT) for common infections including discharge antibiotics. Methods: This retrospective cross-sectional analysis was derived from an IRB-approved, multihospital, quasi-experiment at a 5-hospital health system in southeastern Michigan. The study population included patients discharged from an inpatient general and specialty practice ward on oral antibiotics from November 2018 through April 2019. Patients were included with the following diagnoses: skin and soft-tissue infections (SSTIs), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), respiratory viral infections, acute exacerbation of chronic obstructive pulmonary disease (AECOPD), intra-abdominal infections (IAIs), and urinary tract infections (UTIs). Other diagnoses were excluded. Data were extracted from medical records including antibiotic indication, selection, and duration, as well as patient characteristics. Results: In total, 1,574 patients were screened and 800 patients were eligible for inclusion. The most common antibiotic indications were respiratory tract infections, with 487 (60.9%) patients. These included 165 AECOPD cases (20.6%) and 200 CAP cases (25%) with no multidrug resistant organism (MDRO) risk factors; 57 patients (7.1%) with MDRO risk factors; HAP in 7 patients (0.9%); and influenza in 58 patients (7.2%). Also, 205 (25.6%) patients were diagnosed with UTIs: 71 with cystitis (8.9%), 86 (10.8%) with complicated UTI (cUTI), and 48 (6%) with pyelonephritis. Furthermore, 125 patients (15.6%) were diagnosed with SSTI: 59 (7.4%) purulent and 66 (8.3%) nonpurulent. 31 (3.9%) patients had an IAI. The most commonly used antibiotics were cephalosporins in 536 patients (67%), azithromycin in 252 patients (31.5%), and fluroquinolones and tetracyclines in 231 patients (28.9%). Fluroquinolones were the most frequent antibiotic prescribed at discharge in 210 patients (26.3%). Figure 1 displays the average DOT relative to specific indications. The median duration of total antibiotic therapy exceeded institutional guideline recommendation for multiple conditions, including AECOPD (7 days vs recommended 5 days), CAP with COPD (8.3 vs 7 days ), CAP without COPD (7.7 vs 5 days), and pyelonephritis (11 vs 7–10 days). Also, 269 (33.6%) patients received unnecessary therapy; 218 (27.3%) of these were due to excess duration. Conclusions: Among a cross-section of hospitalized patients, the average DOT, including after discharge, exceeded the optimal therapy for many patients. Further understanding of patterns and influences of antibiotic prescribing is necessary to design effective AMS interventions for improvement.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None

Sign in / Sign up

Export Citation Format

Share Document