The DOOR to Antibiotic Stewardship: Refining Assessments of Interventions With Desirability of Outcome Ranking

2021 ◽  
pp. 089719002098713
Author(s):  
Steven M. Smoke ◽  
Vishal V. Patel ◽  
Nicole I. Leonida
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Diagnostic Testing ◽  
Intervention Group ◽  
Molecular Diagnostic ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
The Impact ◽  
Post Intervention Group

Background: Limited sample size and disparate outcome measures can hinder the ability of antimicrobial stewardship programs to assess the utility of their quality improvement interventions. Desirability of outcome ranking (DOOR) is a novel methodology that incorporates multiple outcomes into a single value to more comprehensively compare therapeutic strategies. The objective of this study was to apply DOOR to a single center antibiotic stewardship intervention. Methods: A pre- and post-interventional study was conducted evaluating the impact of prospective pharmacist review of rapid molecular diagnostic testing (RDT) of blood cultures on antibiotic optimization. Outcomes included the percentage of patients who were switched to appropriate therapy, the time to appropriate therapy, and the percentage of patients who had missed de-escalation opportunities. Results: A total of 19 and 29 patients were included in the final analysis. The percentage of patients reaching appropriate therapy was 84% (16/19) and 97% ([28/29], p = 0.16) in the pre-intervention and post-intervention groups respectively. Median time to appropriate therapy was 26 hours and 36 minutes (IQR 13:05-50:45) and 22:40 (IQR 3:42-48:23, p = 0.32), respectively. One missed de-escalation opportunity was identified in the post-intervention group (0% vs 3%, p = 1.00). DOOR analysis indicated that the probability of a better outcome for the post-intervention group than the pre-intervention group was 58% (95% CI 54-62). Conclusion: In this analysis, DOOR revealed a benefit that would not have been apparent with traditional outcomes assessments. Antimicrobial stewardship programs conducting quality improvement studies should consider incorporating DOOR into their methodology.

scholarly journals 110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Katie A McCrink ◽  
Kailynn DeRonde ◽  
Adriana Jimenez ◽  
Gemma Rosello ◽  
Yoichiro Natori ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Patient Survival ◽  
Intervention Group ◽  
Culture Collection ◽  
Drug Resistant ◽  
Intervention Period ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

scholarly journals Impact of a Pharmacist-Driven Respiratory Viral Panel Stewardship Program on Antibiotic Exposure Within a Multicenter Community Health System

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S353-S353
Author(s):  
Ashley Cubillos ◽  
Sandy Estrada ◽  
Harrison Bachmeier ◽  
Edgar Turner
Keyword(s):  
Antimicrobial Stewardship ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Care Hospital ◽  
Antibiotic Exposure ◽  
Post Intervention ◽  
Stewardship Program ◽  
Laboratory Test Results ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Strategies to ensure optimal use of multiplex polymerase chain reaction (mPCR) testing results for antimicrobial stewardship in acute respiratory infections remain to be elucidated. This study sought to assess the impact of pharmacist intervention (by means of prospective feedback to prescribers) on overall antibiotic exposure in patients with viral-positive mPCR Respiratory Viral Panel (RVP) laboratory test results. Methods This retrospective cohort study included patients ≥18 years of age admitted to an acute care hospital with a viral-positive nasopharyngeal FilmArray Respiratory Panel test result receiving antibiotics for a suspected respiratory tract infection. Immunocompromised patients, patients with RVP samples from bronchiolar lavage, patients in the intensive care unit when samples were obtained, and patients receiving antibiotics for non-respiratory infections were excluded. Antibiotic exposure days, antibiotic discontinuation at 72 hours, and culture-positive bacterial superinfection were compared in two cohorts of patients, before and after the rollout of an educational pharmacist RVP stewardship initiative. Results Median antibiotic exposure days did not differ between the pre- and post-intervention groups (6 days vs. 7 days, P = 0.20). Antibiotic discontinuation at 72 hours was significantly lower in the post-intervention group (38% vs. 25%, P = 0.02). More patients in the post-intervention group had positive bacterial respiratory cultures (2.7% vs. 10%, P = 0.007) and chest radiographs suggestive of pneumonia (34.7% vs. 46%, P = 0.05). Patients with peak serum procalcitonin levels <0.25 ng/mL were more likely to have antibiotics discontinued at 72 hours than those with peak levels ≥0.25 ng/mL (36% vs. 0%, P = 0.02). Conclusion An antimicrobial stewardship initiative by pharmacists among patients with viral-positive RVP results did not appear to impact antibiotic exposure days. Serum procalcitonin levels appeared to influence antibiotic discontinuation decisions. Alternative strategies for maximizing the antimicrobial stewardship impact of RVP testing should be explored. Disclosures All authors: No reported disclosures.

scholarly journals 87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Noor F Zaidan ◽  
Rachel S Britt ◽  
David Reynoso ◽  
R Scott Ferren
Keyword(s):  
Staphylococcus Aureus ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Kidney Injury ◽  
Post Intervention ◽  
Gram Positive ◽  
Stewardship Program ◽  
Screening Protocol ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections. Methods Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020. Results Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted. Conclusion A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted. Disclosures All Authors: No reported disclosures

scholarly journals Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre- and Post-Implementation of a Pharmacy Protocol at a Community Teaching Hospital

2017 ◽  
Vol 52 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Christina Miele ◽  
Mary Taylor ◽  
Aditi Shah
Keyword(s):  
Teaching Hospital ◽  
Vitamin K Antagonists ◽  
Intervention Group ◽  
Adult Patients ◽  
Patient Specific ◽  
Post Intervention ◽  
Appropriate Prescribing ◽  
The Impact ◽  
Post Intervention Group ◽  
Community Teaching

Background Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence. Objective The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist-driven DOAC protocol. Methods Data were collected on adult patients admitted to a community teaching hospital who received DOAC therapy for at least 2 days between January and March 2015 (pre-intervention group) and between January and March 2016 (post-intervention group). These data were analyzed to measure inappropriately prescribed DOACs, defined based on DOAC indication, renal function, drug interactions, and other pertinent patient-specific factors. Prior to the start of data collection for the post-intervention group, a pharmacist-driven protocol was developed and implemented. DOAC education was provided to pharmacists, including an evidence-based prescribing table to guide appropriate DOAC therapy. Comparisons were made between the pre-intervention and post-intervention groups to determine the impact of the pharmacist-driven service on appropriate DOAC prescribing. Results Fifty patients were analyzed in the pre-intervention group compared with 85 patients in the post-intervention group, with a total of 333 and 816 doses administered, respectively. Of the total doses administered, 32.4% were considered inappropriate in the pre-intervention group compared with 13.8% in the post-intervention group (adjusted odds ratio [OR], 0.42, 95% CI, 0.19-0.96; p = 0.039). Conclusions Implementing a pharmacist-driven DOAC service significantly improved appropriate prescribing of these agents. Provider education regarding DOAC use is essential to further increase appropriate prescribing of DOACs, optimize patients' therapy, and prevent adverse drug events.

scholarly journals An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

scholarly journals 102. Effects of an Antimicrobial Stewardship-guided MRSA Nasal Screening Review on Vancomycin Utilization for Respiratory Infections: A Quasi-Experimental Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Ross Pineda ◽  
Meganne Kanatani ◽  
Jaime Deville
Keyword(s):  
Antimicrobial Stewardship ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Small Sample ◽  
Post Intervention ◽  
Predictive Values ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant pathogen in patients with respiratory infections. Guidelines recommend empiric MRSA coverage in patients at increased risk, resulting in substantial vancomycin use. Recent literature highlights the use of MRSA nasal assays as a rapid screening tool for MRSA pneumonia, demonstrating high negative predictive values and allowing for shorter empiric coverage. We aimed to evaluate the impact of MRSA nasal screening review by the antimicrobial stewardship program (ASP) on vancomycin utilization for respiratory infections. Methods This was a retrospective, quasi-experimental, pre-post intervention study. The intervention saw the addition of an MRSA screening review tool into the ASP electronic record, highlighting patients on vancomycin (actively or recently administered) with a negative MRSA screening. Vancomycin days of therapy (DOT) was collected for all orders indicated for a respiratory infection in the two weeks following a negative screening. Additional outcomes include vancomycin total dose and DOT per 1,000 patient days. Outcomes were compared via independent samples t-tests. Results 1,110 MRSA screenings resulted across 2 months, of which the majority were excluded for either not having vancomycin ordered, or for having vancomycin ordered for a non-respiratory indication, leaving 37 and 35 evaluable screenings in the pre- and post-intervention groups, respectively. Regarding vancomycin DOT, we did not identify a significant difference between pre- and post-intervention groups with respective means of 2.45 (SD=1.52) and 2.14 (SD=1.12) (p=0.35). We identified a total 8.78 vancomycin DOT per 1,000 patient days in the pre-intervention group versus 6.69 in the post-intervention group. Conclusion ASP-guided review of MRSA screenings was associated with a nonsignificant decrease in mean vancomycin DOT and lower total DOT per 1,000 patient days for respiratory infections following a negative screen. Given the recent implementation of our intervention, our analysis covered a small sample size, highlighting the need for continued data collection. MRSA screenings are not always fully or immediately utilized in our institution, demonstrating room to de-escalate MRSA-targeted antibiotics. Disclosures All Authors: No reported disclosures

scholarly journals 98. Antibiotic Stewardship Interventions Significantly Improve Preferred Antibiotic Prophylaxis in Total Joint Arthroplasty

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S179-S179
Author(s):  
Katelyn Quartuccio ◽  
Raquel Roberts ◽  
Kelly E Pillinger ◽  
Eric Heintz ◽  
Jessica Stern ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Antibiotic Stewardship ◽  
Primary Outcome ◽  
Intervention Group ◽  
Joint Arthroplasty ◽  
Post Intervention ◽  
Risks Factors ◽  
The Difference ◽  
Orthopedic Patients ◽  
Post Intervention Group

Abstract Background Most patients reporting a penicillin (PCN) allergy can tolerate cefazolin, the preferred prophylaxis in a total joint arthroplasty (TJA). The purpose of this study was to evaluate surgical prophylaxis in patients with a reported PCN allergy undergoing a TJA following a stewardship intervention that included updates to institutional guidelines, reclassification of severe PCN allergy, standardization of ordering processes, and participation of a physician champion. Methods This was a single center, retrospective study of adult orthopedic patients greater than 18 years old who underwent a primary elective TJA at a 261-bed community hospital from March 1, 2017 to August 30, 2017 (pre-intervention) and from March 1, 2019 to August 30, 2019 (post-intervention). The primary outcome was the difference in the composite rate of the following: 1) Patients with a reported non-severe PCN allergy without MRSA risk factors who received cefazolin; 2) Patients with a non-severe PCN allergy with MRSA risks factors who received cefazolin plus vancomycin; and 3) Patients with a severe PCN allergy who received vancomycin prior to a primary elective TJA. Results A total of 180 patients with a documented PCN allergy were evaluated (90 patients in the pre-intervention group and 90 patients in the post-intervention group). Rash and hives were the most commonly reported allergies in both groups (71% vs 61%, P=0.2076). Post-intervention revealed a significant increase in the primary outcome of appropriate perioperative antibiotic (55% vs 91%, P&lt; 0.001), largely driven by patients with non-severe allergy [47% (36/76) vs 96% (73/76), P&lt; 0.001]. No patients had signs of an allergic reaction thought to be due to cefazolin, including 8 patients with severe PCN allergy. No patients in either group developed a surgical site infection or C. difficile infection within 90 days post-procedure. Conclusion A multifaceted antibiotic stewardship intervention increased preferred prophylaxis in elective primary TJA. Patients with non-severe PCN allergies, even those reporting hives or local swelling, can tolerate cefazolin without issue. Patients with severe PCN allergy should undergo further evaluation as cefazolin may be a safe option. Disclosures Katelyn Quartuccio, PharmD, BCPS, AstraZeneca (Consultant) Kelly E. Pillinger, PharmD, BCIDP, Pharmacy Times (Other Financial or Material Support, Speaker)

Genetic counseling and testing rates among community cancer programs for patients with breast cancer following site-directed quality improvement.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10529-10529
Author(s):  
Leigh Boehmer ◽  
Latha Shivakumar ◽  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Stephanie A. Cohen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Genetic Counseling ◽  
Family History ◽  
Early Onset ◽  
Intervention Group ◽  
Test Results ◽  
Post Intervention ◽  
Her 2 ◽  
Post Intervention Group

10529 Background: National Comprehensive Cancer Network (NCCN) guidelines recommend testing for highly penetrant breast/ovarian cancer genes in several scenarios, including women with early-onset (≤ 45 years) or metastatic HER-2 negative breast cancer regardless of family history. A 2018 Association of Community Cancer Centers (ACCC) survey (N = 95) showed that > 80% of respondents reported ≤ 50% testing rate of patients with breast cancer who met guidelines. To improve rates of genetic counseling(GC)/testing, ACCC partnered with 15 community cancer programs to support site-directed quality improvement (QI) interventions. Methods: Pre- and post-intervention data from 9/15 partner programs for genetically at-risk women with early-onset or HER-2 negative metastatic breast cancer (MBC) were analyzed. Pre-intervention data were collected between 01/01/2017 and 06/30/2019 while post-intervention data were collected as early as 07/01/2019 and as late as 10/01/2020. QI project scope ranged from creation of testing eligibility education to implementation of a virtual GC clinic. De-identified data collected included: family history documentation; GC appointment; test results; and timing of results relative to surgical date. Results: The pre-intervention cohort included 2691 women and the post- cohort included 3104 women who were eligible for GC. Early-onset patients in the post-intervention group attended a GC appointment 83% (331/401) of the time and 74% (296/401) had genetic test results, with 92% (271/296) receiving results before surgery. Sixty-one percent (1387/2267) of women with HER-2 negative MBC in the post-intervention group received GC, compared to 36% (658/1845) in the pre-intervention group. There was an overall increase in the number of MBC patients with documented test results following GC in the post-intervention cohort (55% (1243/2267) versus 15% (273/1845); p < 0.0001). Rates of GC appointments improved overall, regardless of family history documentation. Rates among those with a documented high-risk family history improved from 57% (729/1284) to 85% (1485/1741) following QI interventions (p < 0.0001). There was also a significantly higher rate of GC provided in the post-intervention group among women with negative family histories (40% (462/1155) versus 23% (181/778); p < 0.0001). GC also increased from 6% (35/629) to 45% (94/208) of women in the post-intervention cohort with no documentation of family history (p < 0.0001). Conclusions: Genetic testing is underutilized in women with breast cancer. Significant improvement was achieved with QI initiatives specifically designed to target easily identified populations meeting guidelines for GC/testing. This project demonstrates the importance of attention to practice-directed strategies aimed at improving identification of risk as well as follow through to GC/testing.

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

2014 ◽  
Vol 35 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Jason M. Pogue ◽  
Ryan P. Mynatt ◽  
Dror Marchaim ◽  
Jing J. Zhao ◽  
Viktorija O. Barr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Intervention Group ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Appropriate Therapy ◽  
The Impact

Objective.To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.Design.Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.Setting.Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.Patients.All patients with monomicrobial gram-negative bacteremia during the study period.Intervention.Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).Results.Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).Conclusions.Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

scholarly journals 143. Modification of Linezolid Restriction Criteria Reduces ICU Gram-positive Antibiotic Consumption

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S201-S202
Author(s):  
John M Boulos ◽  
Kathryn DeSear ◽  
Bethany Shoulders ◽  
Veena Venugopalan ◽  
Stacy A Voils ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Intervention Group ◽  
Hospital Length Of Stay ◽  
Post Intervention ◽  
Gram Positive ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Secondary Outcomes ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Antibiotic time out (ATO) policies have been proposed by the Centers for Disease Control and Prevention to limit unnecessary use of antibiotics. Critically ill patients are often treated empirically with MRSA-active agents for a prolonged duration. The objective of this study was to assess the impact of an ATO policy by targeting empiric gram-positive coverage. Methods Before this intervention, linezolid required pre-approval by the antimicrobial stewardship program or infectious diseases (ID) consult service before dispensing, and no automatic ATO policy was in place for any agent. In 2018, restriction of linezolid was modified to allow 72 hours of empiric use in the intensive care unit (ICU). This retrospective, single-center, pre- post-intervention study looked at eight ICUs at our institution from two equal periods. Adults (age ≥ 18 years) were included who received an IV gram-positive antibiotic (IVGP-AB), specifically linezolid or vancomycin, used for empiric therapy and were admitted to the ICU. The primary outcome was antimicrobial consumption of IVGP-AB defined as days of therapy (DOT) per patient. Secondary outcomes included in-hospital length of stay (LOS), ICU LOS, in-hospital mortality, 30-day readmission, and incidence of acute kidney injury (AKI). Figure 1. Flowchart of patient inclusion into the study Results 2718 patients met criteria for inclusion in the study. 1091 patients were included in the pre-intervention group and 1627 patients were included in the post-intervention group. Baseline characteristics between the two groups were similar, with ID consults being higher in the pre-intervention group. Total mean DOT of IVGP-AB in pre- and- post-intervention groups was 4.97 days vs. 4.36 days, p&lt; 0.01. Secondary outcomes of in-hospital LOS, ICU LOS, and in-hospital mortality did not vary significantly between groups. Thirty-day readmission was lower in the post-intervention group (12.9% vs. 3.9%, p&lt; 0.01). AKI did not differ significantly between groups, however the need for renal replacement therapy was higher in the pre-intervention group (1.2% vs. 0.2%, p&lt; 0.01). Conclusion This study assessed the impact of an ATO policy allowing 72 hours of empiric linezolid in the ICU. We found a statistically significant reduction in days of therapy of IVGP-AB without increases in LOS, mortality, readmission, and AKI. Disclosures All Authors: No reported disclosures

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