scholarly journals 187. Significant Decline in Carbapenem Use with Multifaceted Antimicrobial Stewardship Program (ASP) Interventions

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S99-S100
Author(s):  
Ashlesha Kaushik ◽  
Sandeep Gupta ◽  
Erin Lettow ◽  
Jenna Lundsgaard ◽  
Corey Thieman ◽  
...  
Keyword(s):  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Cost Savings ◽  
Significant Decline ◽  
World Health ◽  
Antimicrobial Stewardship Program ◽  
Intervention Period ◽  
Stewardship Program ◽  
Days Of Therapy

Abstract Background Per World Health Organization, carbapenems should be key targets for antibiotic stewardship programs. Methods A multifaceted antimicrobial stewardship program (ASP) was implemented in January 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem use during pre ASP intervention period (P1: 07/01/2016-12/31/2017) was compared with ASP intervention period (P2: 01/01/2018-06/30/2019). ASP interventions included: providing educational pearls in monthly physician newsletter; educational posters in high-traffic provider areas; suppression of carbapenem results on microbiology susceptibility reports; distributing monthly carbapenem use data to providers; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; generating pharmacy decision-support software algorithms to aid in identifying intervention opportunities; removing carbapenems from order-sets where appropriate. Additional ASP pharmacist interventions: limiting double antibiotic coverage for pseudomonas/anaerobes; de-escalation recommendations. Results Carbapenem use declined significantly from a mean of 64.81 days of therapy (DOT) per 1000 patient days during P1 to 8.91 DOT per 1000 patient days in P2 (p< 0.001). All hospital units showed a significant decrease in carbapenem use, with intensive care step-down unit noting 85.7% reduction (p < 0.00001); floors (medicine, pediatric, surgery) with 61.6% reduction (p< 0.00001); and intensive care units with 52% reduction (p< 0.00001) during P2 compared to P1. Defined daily doses per 1000 patient days decreased from 314.9 in P1 to 93.4 in P2 (p< 0.00001). During P2, 58.3% (132/228) of carbapenem orders were found to be appropriate compared to 37.5% (190/506) in P1 (p< 0.00001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2. No Carbapenem Resistant Enterobacteriaceae isolates were identified. Cost savings of $643 per 1000 patient days were recognized in P2 as a result of reduced carbapenem use. Conclusion There was a significant decline in total carbapenem utilization, an increase in proportion of appropriate use and considerable cost savings as a result of ASP interventions. Disclosures All Authors: No reported disclosures

Sustained Savings from a Longitudinal Cost Analysis of an Internet-Based Preapproval Antimicrobial Stewardship Program

2013 ◽  
Vol 34 (6) ◽  
pp. 573-580 ◽  
Author(s):  
Anna C. Sick ◽  
Christoph U. Lehmann ◽  
Pranita D. Tamma ◽  
Carlton K. K. Lee ◽  
Allison L. Agwu
Keyword(s):  
Cost Analysis ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Cost Savings ◽  
Antimicrobial Stewardship Program ◽  
Pediatric Hospital ◽  
Antimicrobial Prescribing ◽  
Approval Rate ◽  
Stewardship Program ◽  
Sustained Reduction

Objective.To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.Design.Retrospective cohort study and cost analysis.Methods.Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.Results.Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.Conclusions.A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.

scholarly journals 1134. The Effect of Telehealth Antimicrobial Stewardship Program on Antimicrobial Use in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S658-S658
Author(s):  
Mohammad Alghounaim ◽  
Ahmed Abdelmoniem ◽  
Mohamed Elseadawy ◽  
Mohammad Surour ◽  
Mohamed Basuni ◽  
...  
Keyword(s):  
Intensive Care ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Pediatric Intensive Care ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Research Support ◽  
Material Support ◽  
Stewardship Program ◽  
Days Of Therapy

Abstract Background Inappropriate antimicrobial use is common in pediatric intensive care units (PICU). We aimed to evaluate the effect of telehealth antimicrobial stewardship program (ASP) on the rate of PICU antimicrobial use in a center without a local infectious diseases consultation service. Methods Aretrospective cohort study was performed between October 1st, 2018 and October 31st, 2020 in Farwaniyah Hospital PICU, a 20-bed unit. All pediatric patients who were admitted to PICU and received systemic antimicrobials during the study period were included and followed until hospital discharge. Patients admitted to the PICU prior to the study period but still receiving intensive care during the study period were excluded. Weekly prospective audit and feedback on antimicrobial use was provided starting October 8th, 2019 (post-ASP period) by the ASP team. A pediatric infectious diseases specialist would join ASP rounds remotely. Descriptive analyses and a pre-post intervention comparison of days of therapy (DOT) were used to assess the effectiveness of the ASP intervention Results There were 272 and 152 PICU admissions before and after initiation of ASP, respectively. Bronchiolitis and pneumonia were the most common admission diagnoses, together compromising 60.7% and 61.2% pre- and post-ASP. Requirement for respiratory support was higher post-ASP (76.5% vs 91.5%, p< 0.001). Average monthly antimicrobial use decreased from 92.2 (95% CI 74.5 to 100) to 48.5 DOT/1,000 patient-days (95% CI 24.6 to 72.2, P < 0.05) (figure). A decline in DOT was observed across all antibiotic classes, except for ceftriaxone and clarithromycin. No effect on length of PICU stay, hospital length of stay, or mortality was observed. Most (89.7%) ASP recommendations were followed fully or partially changes in antimicrobial days of therapy (DOT)/1,000 patient-days over time. The dashed line represents the start of the antimicrobial stewardship program (ASP) Conclusion In settings where infectious diseases services are not available, telehealth stewardship can be effectively implemented and associated with a significant reduction of antimicrobial use. Disclosures Jesse Papenburg, MD, AbbVie (Grant/Research Support, Other Financial or Material Support, Personal fees)Medimmune (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seegene (Grant/Research Support, Other Financial or Material Support, Personal fees)

scholarly journals 45. Significantly Decreased Broad Spectrum Antimicrobial Use (Carbapenems And Fluoroquinolones) with Implementation of Antibiotic Stewardship Program (ASP) and Pharmacist Interventions

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Ashlesha Kaushik ◽  
Sandeep Gupta ◽  
Corey Thieman ◽  
Michael Padomek
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Intervention Period ◽  
Hospital Units ◽  
Carbapenem Resistant ◽  
Pharmacist Interventions ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Discontinue Therapy

Abstract Background According to the WHO, carbapenems and fluoroquinolones (FQ) should be key targets for stewardship programs. Methods A multifaceted antimicrobial stewardship program (ASP) was implemented in July 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem and FQ use during pre-ASP intervention period (P1: 12/01/2016-6/30/2018) was compared with ASP-intervention period (P2: 07/01/2018-1/31/2020). ASP interventions included: stewardship educational pearls in monthly physician newsletters; educational posters in provider areas; suppression of carbapenem results on microbiology susceptibility reports; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; removing FQ and carbapenems from order-sets where appropriate; default antibiotic stop dates changed to 7 days in EMR (Epic); adverse effects warning fired as an alert when ordering FQ. Pharmacist interventions: procalcitonin protocol allowing pharmacists to reorder follow-up procalcitonin and make recommendations to discontinue therapy where appropriate. Results FQ use declined significantly from a mean of 133 days of therapy (DOT) per 1000 days to 46 DOT per 1000 patient days during P2 (p< 0.0001). Carbapenem use declined significantly from a mean of 65 DOT per 1000 patient days during P1 to 9 DOT per 1000 patient days in P2 (p< 0.001). All hospital units showed a significant decrease in use, with intensive care units (ICUs) noting 56% reduction (p< 0.00001) during P2 compared to P1. During P2, 55% of orders for carbapenems and FQ during P2 were found to be appropriate compared to 39% in P1 (p< 0.0001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2 and no Carbapenem-Resistant Enterobacteriaceae isolates were identified during the study period; FQ sensitivity remained stable at 81%. Cost savings of &757 per 1000 patient days were recognized in P2 as a result of reduced use. Conclusion With ASP and pharmacist interventions, a significant decline in total utilization of carbapenem and FQ, considerable cost savings and an increase in proportion of appropriate use were observed. Disclosures All Authors: No reported disclosures

scholarly journals 57. Financial Impact of a Regional Antimicrobial Stewardship Cost Saving Initiative in a Large Integrated Healthcare System

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S147-S147
Author(s):  
Van Nguyen ◽  
Colton Taylor ◽  
Alyssa Christensen ◽  
Brent Footer
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Cost Savings ◽  
Financial Impact ◽  
Integrated Healthcare ◽  
Medical Centers ◽  
Stewardship Program ◽  
Days Of Therapy

Abstract Background A regional antibiotic stewardship program (ASP) within a large integrated healthcare system covering two, non-academic, tertiary care medical centers and an additional six community hospitals implemented multiple interventions to optimize antimicrobial therapy and reduce unnecessary hospital costs, such as transition to extended-infusion (EI) piperacillin/tazobactam (TZP), formulary restriction of antimicrobials, and antimicrobial stewardship clinical review. The purpose of this study was to evaluate the cost savings associated with these regional ASP initiatives. Methods This was a multicenter, retrospective, observational review of regional stewardship interventions across eight inpatient medical centers in Oregon. Data was collected from January 2019 to December of 2020. Cost savings associated with reduced TZP administrations was based on the duration of therapy for each encounter in adults who received TZP for >24 hours in 2020. The regional antimicrobial restriction policy was implemented in February 2020. Cost savings attributed to antimicrobial formulary restrictions and reduction in overall days of therapy/1000 patient days (DOT) were based on EPIC costs. Results The reduction in number of administrations with implementation of EI TZP resulted in &226,420 saved in 2020. &182,837 was saved due to decreased usage of restricted antimicrobial agents. An additional &433,341 was saved for overall antimicrobial costs due to 19,775 days reduction in overall DOT/1000 patient days. Conclusion A community-based regional ASP has resulted in substantial financial impact and identified areas for future cost savings within the region. Disclosures All Authors: No reported disclosures

scholarly journals 64. Impact of a Duration Bundle on Antimicrobial Use in a Pediatric Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S52-S52
Author(s):  
Erin Weslander ◽  
Diana Li ◽  
Xuanqing Wang
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Average Length ◽  
Cost Savings ◽  
Antimicrobial Stewardship Program ◽  
Pediatric Hospital ◽  
Intervention Period ◽  
Average Length Of Stay ◽  
Stewardship Program ◽  
The Impact

Abstract Background Limiting antibiotic durations to the shortest effective duration is a strong recommendation with moderate-quality evidence in the 2016 IDSA Antimicrobial Stewardship Program (ASP) guidelines. An ASP bundle including a decrease in antimicrobial automatic stop dates from 14 days to 10 days along with a guideline for standard durations for 48 specific indications was implemented at a tertiary pediatric hospital in November 2019. The purpose of this review and was to assess the impact of this ASP initiative on patient outcomes and hospital cost-savings by comparison of pre-intervention and post-intervention data. Methods A set of antimicrobial duration recommendations for pediatric patients was created by the Antimicrobial Stewardship Program, Pediatric Hospital Medicine providers, and Infectious Disease providers specific to indication, agent, or pathogen. After education of medical care providers and distribution of the recommendations, automatic stop dates in the Electronic Medical Record (EMR) were updated from 14 days to 10 days for all antimicrobials. Concomitant advertising campaigns were shown on all hospital screensavers. Data were collected for a one month pre-intervention period of Nov.15 - Dec.15, 2018 including 133 patients and a one month intervention period of Nov.15 - Dec.15, 2019 including 125 patients. Results The average length of stay decreased from an average of 8.3 days pre-implementation to 6.7 days (p=0.043) post implementation. The ratio of actual to recommended duration also decreased from 1.56 to 1.30 (p< 0.001) when comparing pre vs. post initiative. Balancing measures did not change for restarting treatment within 48 hours of stopping or readmission within 30 days for the same infection. The decrease in inpatient therapy translated to more than $10,000 per year in direct drug cost. Conclusion This intervention lead to a significant reduction in average length of stay per admission and significantly reduced the secondary outcomes of the total duration of antimicrobial therapy and the ratio of actual duration compared to recommended duration. This lead to cost savings and decreased inappropriate antibiotic exposure. Disclosures All Authors: No reported disclosures

scholarly journals Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 470
Author(s):  
Dipu T. Sathyapalan ◽  
Jini James ◽  
Sangita Sudhir ◽  
Vrinda Nampoothiri ◽  
Praveena N. Bhaskaran ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Successful Implementation ◽  
Loading Dose ◽  
Antimicrobial Stewardship Program ◽  
Entire Study ◽  
Stewardship Program ◽  
South Indian ◽  
Implementation Period ◽  
The Right

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

Antimicrobial Prophylaxis Use in the Neonatal Intensive Care Unit: An Antimicrobial Stewardship Target That Deserves Attention!

2021 ◽  
Author(s):  
Isabelle Viel-Thériault ◽  
Amisha Agarwal ◽  
Erika Bariciak ◽  
Nicole Le Saux ◽  
Nisha Thampi
Keyword(s):  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Audit And Feedback ◽  
Clinical Indication ◽  
Surgical Prophylaxis ◽  
Early Onset Sepsis ◽  
Days Of Therapy ◽  
Antibiotic Courses

Objective Previous analyses of neonatal intensive care units (NICU) antimicrobial stewardship programs have identified key contributors to overall antibiotic use, including prolonged empiric therapy >48 hours for early-onset sepsis (EOS). However, most were performed in mixed NICU settings with onsite birthing units, resulting in a high proportion of inborn patient admissions. The study aimed to describe and analyze the most common reasons for antimicrobial use in an outborn tertiary care NICU. Study Design This was a 10-month review of all antimicrobial doses prescribed in a 20-bed level III NICU. The primary outcome was the total days of therapy (DOT) and length of therapy (LOT) for each clinical indication. Secondary outcomes included total DOT for each antimicrobial and appropriateness of antimicrobial courses. Results Of 235 antibiotic courses and 1,899 DOT (519 DOT/1,000 patient days) prescribed in 173 infants during the study period, the most common indications were suspected EOS, followed by prophylaxis. Among the 85 DOT/1,000 patient days (PD; 38 courses) prescribed for prophylaxis, 52.5 DOT/1,000 PD (25 courses; 62%) were for surgical prophylaxis. Of 17 postoperative antibiotic courses, 15 (88.2%) were deemed to be inappropriate mostly due to a duration greater than 24 hours postoperatively (n = 13; median LOT = 3 days). Conclusion Surgical prophylaxis is a common reason for antimicrobial misuse in outborn NICU. NICU-based prospective audit and feedback between neonatologists and antimicrobial stewardship teams alone may not be impactful in this setting. Partnerships with neonatologists and surgeons will be key to achieving the target of less than 24 hours of postoperative antimicrobials. Key Points

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.

The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities

2018 ◽  
Vol 39 (12) ◽  
pp. 1400-1405 ◽  
Author(s):  
Erika M. C. D’Agata ◽  
Curt C. Lindberg ◽  
Claire M. Lindberg ◽  
Gemma Downham ◽  
Brandi Esposito ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Prescribing Patterns ◽  
Antimicrobial Stewardship Program ◽  
Intervention Period ◽  
Positive Effects ◽  
Antimicrobial Prescribing ◽  
Stewardship Program ◽  
Dialysis Facilities

AbstractBackgroundAntimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.ObjectiveTo quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.ResultsImplementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.ConclusionsWithin 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.

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