scholarly journals 1030. Analysis of a Novel Mortality Prediction Rule for Organizing and Guiding Antimicrobial Stewardship Team Activities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S362-S363
Author(s):  
Curtis D Collins ◽  
Caleb Scheidel ◽  
Christopher J Dietzel ◽  
Lauren R Leeman ◽  
Cheryl A Morrin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Risk Score ◽  
Antimicrobial Stewardship ◽  
Prediction Rule ◽  
Mortality Prediction ◽  
Audit And Feedback ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Antimicrobial stewardship team (AST) surveillance at our hospital is facilitated by an internally-developed database. In 2013, the database was expanded to incorporate a validated internally-developed prediction rule for patient mortality within 30 days of hospital admission. AST prospective audit and feedback expanded to include all antimicrobials prescribed in patients with the highest risk for mortality determined by risk score. This study describes the impact of an expanded AST review in patients at the highest risk for mortality. Methods This retrospective, observational study analyzed all adult patients with the highest mortality risk score who received antimicrobials not historically captured via AST review. Patients were identified through administrative and AST databases. Study periods were defined as 2011 – Q3 2013 (historical group) and Q4 2013 – 2018 (intervention group). Primary and secondary outcomes were assessed for confounders including demographic data and infection-related diagnoses. Outcomes were assessed using both unweighted and propensity score weighted versions of the t-test or Wilcoxon rank-sum test for continuous variables and the chi-squared test or Fisher’s Exact test for discrete variables. Results A total of 2,852 and 5,460 patients were included in the historical and intervention groups, respectively. After adjusting for demographic and clinical characteristics, there were significant reductions in median antimicrobial duration (5 vs. 4, P = 0.002), antimicrobial days of therapy (7 vs. 7, P = 0.001), length of stay (LOS) (6 vs. 5 days, P = 0.001), intensive care unit (ICU) LOS (3 vs. 2 days, P < 0.001), and total hospital cost ($11,017 vs. $9,134, P < 0.001) in the intervention cohort. There were no significant differences observed in 30-day mortality or 30-day readmissions. Secondary analyses showed significant decreases in fluroquinolone and intravenous vancomycin utilization between cohorts. Conclusion Reductions in antimicrobial use, inpatient and ICU length of stay, and total hospital costs were observed in a cohort of patients following incorporation of a novel mortality prediction rule to guide AST surveillance. Disclosures All authors: No reported disclosures.

scholarly journals Impact of a mortality prediction rule for organizing and guiding antimicrobial stewardship program activities

2021 ◽  
Author(s):  
Curtis D Collins ◽  
Scott Kollmeyer ◽  
Caleb Scheidel ◽  
Christopher J Dietzel ◽  
Lauren R Leeman ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Intervention Group ◽  
Prediction Rule ◽  
Interrupted Time Series ◽  
Healthcare Facility ◽  
Mortality Prediction ◽  
Total Hospital Cost ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
The Impact

Abstract Background Antimicrobial stewardship program (ASP) surveillance at our hospital is supplemented by an internally developed surveillance database. In 2013, the database incorporated a validated, internally developed, prediction rule for patient mortality within 30 days of hospital admission. This study describes the impact of an expanded ASP review in patients at the highest risk for mortality. Methods This retrospective, quasi-experimental study analyzed adults who received antimicrobials with the highest mortality risk score. Study periods were defined as 2011 – Q3 2013 (historical group) and Q4 2013 – 2018 (intervention group). Primary and secondary outcomes were assessed for confounders and analyzed using both unadjusted and propensity score weighted analyses. Interrupted time-series analyses also analyzed key outcomes. Results A total of 3,282 and 5,456 patients were included in the historical and intervention groups, respectively. There were significant reductions in median antimicrobial duration (5 vs. 4 days; p &lt; 0.001), antimicrobial DOTs (8 vs. 7; p &lt; 0.001), antimicrobial cost ($96 vs. $85; p = 0.003), length of stay (LOS) (6 vs. 5 days; p &lt; 0.001), intensive care unit (ICU) LOS (3 vs. 2 days; p &lt; 0.001), total hospital cost ($10,946 vs. $9,119; p &lt; 0.001), healthcare facility-onset vancomycin-resistant Enterococcus (HO-VRE) spp. (1.3% vs. 0.3%; p = &lt; 0.001) and HO-VRE infections (0.6% vs. 0.2%; p = 0.018) in the intervention cohort. Conclusion Reductions in antimicrobial use, hospital and ICU LOS, HO-VRE, HO-VRE infections, and costs were associated with incorporation of a novel mortality prediction rule to guide ASP surveillance and intervention.

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 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 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

scholarly journals Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center

2017 ◽  
Vol 52 (9) ◽  
pp. 628-634 ◽  
Author(s):  
Yanina Dubrovskaya ◽  
Marco R. Scipione ◽  
Justin Siegfried ◽  
Shin-Pung Jen ◽  
Vinh Pham ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Dose Adjustment ◽  
Academic Medical Center ◽  
Audit And Feedback ◽  
Therapeutic Drug ◽  
Antimicrobial Stewardship Program ◽  
Hospital Pharmacists ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Purpose: Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. Summary: During a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed (ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639). Sixty percent of interventions by ASP CPS were initiated utilizing the dedicated ASP phone, and 40% through prospective audit and feedback. Non-ASP CPS performed interventions during bedside rounds (dose adjustment 23%, initiate new or alternative anti-infective 21%, discontinue antibiotic(s) 12%, therapeutic drug monitoring 11%, de-escalation 4%), whereas hospital pharmacists participated at the point of verification (dose adjustment 75%, restricted antibiotic verification 15%, and reporting major drug-drug interactions 4%). The acceptance rate of interventions by providers and clinicians was >90% for all groups. Annual aggregate antimicrobial use decreased by 6.4 days of therapy/1000 patient-days (DOT/1000 PD; P = 1.0). Ceftriaxone use increased by 8.4 DOT/1000 PD ( P = .029) without a significant compensatory increase in the use of antipseudomonal agents. Sustained low rates of hospital-onset Clostridium difficile (CDI) and carbapenem-resistant Enterobacteriaceae (CRE) infections were observed in 2015 compared with the prior year (1.1 and 1.2 cases/1000 PD, 0.2 and 0.1 cases/1000 PD, respectively). Thirty-day readmission rate decreased by 0.6% ( P = .019). Conclusions: Integration of all pharmacists into ASP activities based on the level of patient care and responsibilities is an effective strategy to expand clinical services provided by ASP.

Are There Differences in Hospital Cost Between Patients With Nosocomial Methicillin-ResistantStaphylococcus aureusBloodstream Infection and Those With Methicillin-SusceptibleS. aureusBloodstream Infection?

2009 ◽  
Vol 30 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Debby Ben-David ◽  
Ilya Novikov ◽  
Leonard A. Mermel
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Hospital Cost ◽  
Methicillin Resistance ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Icu Patients ◽  
The Difference ◽  
The Impact ◽  
Multivariable Adjustment

Objective.To examine the impact of methicillin resistance on in-hospital mortality, length of stay, and hospital cost after the onset of nosocomialStaphylococcus aureusbloodstream infection (BSI).Design.A retrospective cohort study.Setting.A tertiary care hospital in Rhode Island.Patients.A cohort of 182 consecutive patients who developed nosocomial BSI due to methicillin-susceptible and methicillin-resistantS. aureus(MSSA and MRSA, respectively)Results.Patients with MRSA BSI had a significantly longer total length of hospital and intensive care unit (ICU) stay before the onset of BSI and a higher average daily cost. Compared with ICU patients with MSSA BSI, those with MRSA BSI had a higher median total hospital cost ($42,137 vs $113,852), higher hospital cost after infection ($17,603 vs $51,492), and greater length of stay after infection (10.5 vs 20.5 days). After multivariable adjustment, ICU patients with MRSA BSI had significantly increased total hospital cost, hospital cost after infection, and length of stay after infection. However, using a propensity score approach, we found that, among ICU patients, the difference in cost after infection and the difference in length of stay after infection for MRSA, compared with MSSA BSI, were not significant. The differences among non-ICU patients who developed MRSA or MSSA BSI were not significant after multivariable adjustment or by propensity score.Conclusions.On the basis of propensity score, we found that methicillin resistance did not independently increase hospital cost or length of stay after onset ofS. aureusBSI. We believe that use of a propensity score on a comparable subset of patients may be a better method than multivariable adjustment for assessing the impact of methicillin resistance in cohort studies.

Evaluating a Pharmacy-Driven 72-Hour Antibiotic Monitoring Program Implemented in a Community Hospital

2019 ◽  
pp. 001857871986766
Author(s):  
Vishal Patel ◽  
Shaina Doyen
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Community Hospital ◽  
Monitoring Program ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Broad Spectrum Antibiotic ◽  
Days Of Therapy ◽  
The Impact

Background: Antimicrobial stewardship programs commonly utilize infectious diseases pharmacists to guide appropriate utilization of broad-spectrum antimicrobials. Strategies should be developed to increase staff pharmacist’s participation in decreasing broad-spectrum antibiotic use. Objective: The purpose of this study was to determine the effectiveness of a pharmacy-driven 72-hour antimicrobial stewardship initiative. Methods: A pharmacy-driven 72-hour antibiotic review policy was implemented at a community hospital. Targeted antibiotics included ertapenem, meropenem, and daptomycin. The hospital’s infectious diseases pharmacist provided policy education to staff pharmacists. All pharmacists provided prospective audit and feedback to physicians. Preimplementation and postimplementation data were collected through a retrospective chart review to analyze the impact of the initiative. Results: There were a total of 570 targeted antibiotic orders for review, of which 155 antibiotic orders met criteria for inclusion; 97 in the preimplementation group and 58 in the postimplementation group. Targeted antibiotic orders decreased postimplementation during the study period. Days of therapy per 1000 patient days decreased between the 2 groups, although this was statistically significant neither for the pooled targeted antibiotics nor for each individual antibiotic. There was a statistically significant increase in the number of appropriately prescribed targeted antibiotics from preimplementation compared to postimplementation (from 35% to 64%, P < .01). Pharmacist interventions documented for patients receiving the targeted antibiotics increased significantly during the intervention period ( P < .01). In addition, there was a total of $28 795.96 in cost avoidance based on the difference in antibiotic use between the 2 groups. Conclusion: Implementation of a pharmacy-driven 72-hour broad-spectrum antibiotic review in a large community-based hospital resulted in a reduction in utilization and hospital spending and a significant increase in appropriate use of targeted antibiotics, while also increasing pharmacist engagement with antimicrobial stewardship.

scholarly journals 96. Assessing the Impact of the Meningitis/encephalitis Diagnostic Panel on Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S63-S63
Author(s):  
Jonathan Garellek ◽  
Thien-Ly Doan ◽  
Shawn Varghese ◽  
Rebecca Schwartz ◽  
Rehana Rasul ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Hospital Readmissions ◽  
Empiric Therapy ◽  
Rank Test ◽  
Test Time ◽  
Standard Group ◽  
Days Of Therapy ◽  
The Impact ◽  
Pcr Test

Abstract Background The multiplex polymerase chain reaction (PCR) test for meningitis/encephalitis (ME) is an assay that is available to detect 14 organisms in 2 hours from the cerebral spinal fluid. The primary objective was to assess the clinical impact of this assay on antimicrobial stewardship. Methods This is an IRB-approved, retrospective cohort study of a random sample of patients admitted between 7/2015 - 12/2018, stratified by season. A chart review was performed to collect: demographics, microbiology/treatment data, length of stay, hospital readmissions, and mortality. Differences for ME PCR versus culture only were assessed using Chi-square test or Fisher’s exact test. Time to de-escalation of empiric therapy was compared using the log-rank test. Results The study consisted of 241 patients, of whom 161 (66.8%) had CSF-PCR testing performed. Mean age was 51.76. There was an even distribution of males and females. Aside from patients with HIV, who were more represented in the standard period, there were no differences by comorbidity. The etiology of meningitis was greater in the PCR compared to the non-PCR group (10.5% vs. 2.5% in PCR and non-PCR respectively). Time to de-escalation of empiric therapy was significantly shorter in the PCR period (median [IQR]: 43.06 [26.9–47.7] vs. 64.62 [37.18–83.33], P&lt; 0.004). Total days of therapy of antibiotics was longer among the PCR group, but not statistically significant (median [IQR] = 4 [1–7] vs. 2 [1–4], P=0.121). Median length of stay was higher in the PCR period compared to the standard group (median [IQR]: 9 [6 - 15] vs. 5.5 [3 - 8.5], P&lt; 0.004). Readmission rates did not differ (PCR 13.7% vs. non-PCR 16.3%, P=0.592). More died during the PCR period (8.6% vs. 3.8%, P=0.16) but this was not statistically significant. Conclusion The ME PCR was associated with an earlier time to antibiotics de-escalation. Patients that had the PCR test performed had more days of therapy and longer length of stay, but this is likely due to a higher rate of pathogen diagnosed. There was no association in readmissions. The initiation of rapid diagnostic testing in a healthcare settings has the potential to improve patient outcomes and may help antimicrobial stewardship by shortening the time to de-escalating antimicrobials and offering appropriate targeted therapy. Disclosures All Authors: No reported disclosures

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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.

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