scholarly journals Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19

2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Lydia R Rahem ◽  
Bénédicte Franck ◽  
Hélène Roy ◽  
Denis Lebel ◽  
Philippe Ovetchkine ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Pediatric Population ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Defined Daily Dose ◽  
Centre Hospitalier ◽  
Stewardship Program ◽  
Centre Hospitalier Universitaire ◽  
Days Of Therapy

Background: Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. Objective: To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. Methods: In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. Results: Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/ maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). Conclusions: This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program. RÉSUMÉ Contexte : La gestion des antimicrobiens est une pratique courante dans les centres hospitaliers afin de réduire l’utilisation inappropriée des antimicrobiens et le risque de résistance. Objectif : Décrire l’évolution de l’utilisation des antimicrobiens dans un centre hospitalier universitaire de 2015-16 à 2018-19. Méthodes : Dans cette étude rétrospective, descriptive et transversale, les dossiers pharmacologiques ont servi à déterminer le nombre de jours de traitement (NJT) et la dose définie journalière (DDD) par 1000 jours-présence (JP) pour chaque antimicrobien et pour chaque unité de soins par année de l’étude. Pour chaque mesure, on a également comparé le ratio de 2018-19 à celui de 2015-16, qui est exprimé en proportion; lorsque la valeur de cette proportion était ≤ 0,8 ou ≥ 1,2, ce qui indiquait un changement important durant la période de l’étude, une note explicative a été attribuée par consensus. Résultats : Durant la période à l’étude, 94 antimicrobiens ont été disponibles dans notre centre : 70 antibiotiques (dont les antiparasitaires et les antituberculeux), 14 antiviraux et 10 antifongiques. Le nombre total de NJT par 1000 JP a diminué de 904 en 2015-16 à 867 en 2018-19. Les cinq antimicrobiens utilisés le plus fréquemment et présentés en minimum / maximum de NJT par 1000 JP étaient les suivants : piperacilline-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicilline (51/69), vancomycine (53/68) et cefotaxime (55/58). Pendant la même période, les unités de soins qui faisaient la plus grande utilisation d’antimirobiens (exprimée en minimum / maximum de NJT par 1000 JP) étaient hématologie-oncologie (2529/2723), pédiatrie (1006/1408) et soins intensifs pédiatriques (1328/1717). Conclusions : Cette étude démontre une consommation stable d’antimicrobiens entre 2015-16 et 2018-19 dans un centre hospitalier universitaire mère-enfant canadien. Malgré le fait que la consommation entre les groupes d’antimicrobiens (antibiotiques, antiviraux, antifongiques) était stable, on a constaté d’importantes variations concernant certains médicaments individuels. Plusieurs facteurs peuvent expliquer cette variation, notamment des ruptures d’approvisionnement, des changements de pratique et des changements dans la prévalence d’infections. La surveillance de la consommation des antimicrobiens est une partie essentielle de tout programme d’antibiogouvernance.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

scholarly journals Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 41 ◽  
Author(s):  
Joshua Knight ◽  
Jessica Michal ◽  
Stephanie Milliken ◽  
Jenna Swindler
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Hospital System ◽  
Physician Review ◽  
Stewardship Program ◽  
Time Period ◽  
Days Of Therapy ◽  
Before And After ◽  
Implementation Time ◽  
Acceptance Rates

While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.

scholarly journals Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica

2020 ◽  
Vol 44 ◽  
pp. 1
Author(s):  
José Pablo Díaz-Madriz ◽  
Eugenia Cordero-García ◽  
José Miguel Chaverri-Fernández ◽  
Esteban Zavaleta-Monestel ◽  
Josué Murillo-Cubero ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Private Hospital ◽  
Bacterial Resistance ◽  
Defined Daily Dose ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Daily Dose ◽  
Resistance Patterns ◽  
The Impact

Objective. To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital. Methods. This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014–2015 and 2016–2017 were compared. Results. Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% (p < 0.001). Regarding percentage of bacterial resistance, in most bacterial isolates no statistically significant changes were observed between the two periods. Conclusions. A reduction in the overall consumption of antibiotics has been achieved over time, most likely attributable to the antimicrobial stewardship program. However, this trend was not observed for all the antibiotics studied. The pattern of resistance among the commonly isolated microorganisms did not vary greatly between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.

scholarly journals 101. Impact of an Integrated Tele-Antimicrobial Stewardship Program at a Rural Community Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S164-S165
Author(s):  
Sui Kwong Li ◽  
Erin K McCreary ◽  
Erin K McCreary ◽  
Tina Khadem ◽  
Nancy Zimmerman ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Resistant Bacteria ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Material Support ◽  
Stewardship Program ◽  
Days Of Therapy

Abstract Background Small hospitals in the US may lack access to infectious diseases (ID) expertise despite similar rates of antimicrobial use and drug-resistant bacteria as larger hospitals. A tele-antimicrobial stewardship program (TASP) is a force multiplier, expanding access to specialty care, training, and guidance on appropriate resource utilization. Data on the impact of TASPs in community or rural inpatient settings is limited. Methods We established a TASP at a 160-bed hospital in Armstrong County, PA (population &lt; 5000) in September 2020. Tele-ID consult services were already being used (Figure 1). A non-local ID pharmacist or ID physician performed prospective audits and provided feedback with 1 local pharmacist on a 30-minute video conference call daily. At TASP implementation, all patients receiving intravenous (IV) fluoroquinolones, metronidazole, and azithromycin were reviewed. Figure 1 shows the additional support following TASP implementation, including addition of ceftriaxone, carbapenems, IV vancomycin, and tocilizumab to daily reviews. A patient monitoring form was developed to track interventions and the local pharmacists were trained in documentation. Table 1 lists other TASP features implemented. Figure 1. TASP Timeline Table 1. TASP Accomplishments Results From 09/01/2020 to 04/30/2021, 304 stewardship opportunities were identified and 77% of interventions were accepted. Recommending a duration of therapy was accepted most frequently (93.5%) and de-escalation of therapy least frequently (69.6%) (Table 2). Recommending an ID consultation or diagnostic testing was always accepted but only comprised 6.2% of all interventions. Daily calls involved an average of 5 patient reviews. Monthly antimicrobial use declined on average from 673 DOT (days of therapy)/1000 PD (patient days) to 638 DOT/1000 PD (Figure 2). Daily calls were cancelled on 31/166 weekdays (18.7%) due to staffing shortages. Table 2. TASP Interventions (9/2020 - 4/2021) Figure 2. Monthly Antimicrobial Use in Days of Therapy (DOT) per 1000 Patient Days (4/2019 - 5/2021) Conclusion Implementation of TASP in a community hospital resulted in a high percentage of accepted stewardship interventions and lower antimicrobial usage. Success is dependent on robust educational efforts, establishing strong relationships with local providers, and involvement of key stakeholders. Lack of dedicated stewardship time for local pharmacists is a very significant barrier. Disclosures Erin K. McCreary, PharmD, BCPS, BCIDP, AbbVie (Consultant)Cidara (Consultant)Entasis (Consultant)Ferring (Consultant)Infectious Disease Connect, Inc (Other Financial or Material Support, Director of Stewardship Innovation)Merck (Consultant)Shionogi (Consultant)Summit (Consultant) Erin K. McCreary, PharmD, BCPS, BCIDP, AbbVie (Individual(s) Involved: Self): Consultant; Cidara (Individual(s) Involved: Self): Consultant; Entasis (Individual(s) Involved: Self): Consultant; Ferring (Individual(s) Involved: Self): Consultant; Infectious Disease Connect, Inc (Individual(s) Involved: Self): Director of Stewardship Innovation, Other Financial or Material Support; Merck (Individual(s) Involved: Self): Consultant; Shionogi (Individual(s) Involved: Self): Consultant; Summit (Individual(s) Involved: Self): Consultant Tina Khadem, PharmD, Infectious Disease Connect, Inc. (Employee) Nancy Zimmerman, RN, BSN, I’d connect (Employee) John Mellors, MD, Abound Bio, Inc. (Shareholder)Accelevir (Consultant)Co-Crystal Pharma, Inc. (Other Financial or Material Support, Share Options)Gilead Sciences, Inc. (Advisor or Review Panel member, Research Grant or Support)Infectious DIseases Connect (Other Financial or Material Support, Share Options)Janssen (Consultant)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Employee, Director of Clinical Operations) Rima Abdel-Massih, MD, Infectious Disease Connect (Individual(s) Involved: Self): Chief Medical Officer, Other Financial or Material Support, Other Financial or Material Support, Shareholder J Ryan. Bariola, MD, Infectious Disease Connect (Other Financial or Material Support, salary support)

scholarly journals 181. Antimicrobial Use in the Time of COVID-19 – Data from 84 VA Facilities

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S219-S220
Author(s):  
Matthew B Goetz ◽  
Christopher J Graber ◽  
Makoto M Jones ◽  
Vanessa W Stevens ◽  
Peter A Glassman ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Lower Respiratory Tract ◽  
Drug Class ◽  
Training Programs ◽  
Antibiotic Use ◽  
Seasonal Effects ◽  
Antimicrobial Use ◽  
Drug Classes ◽  
Stewardship Program ◽  
Days Of Therapy

Abstract Background The VA initiated an antimicrobial stewardship program in 2011, which includes participation in the Center for Disease Control (CDC) Antimicrobial Use Option, educational webinars, training programs for antimicrobial stewards, required staffing & reporting, and quality improvement initiatives, that has led to ongoing decreases in antimicrobial therapy nationwide. With the onset of the COVID-19 pandemic, however, there are several factors that may contribute increases in antimicrobial use (increased presentations of lower respiratory tract infection, concern for bacterial co-infection with SARS-CoV-2, etc.). We sought to compare patterns of antibacterial use in the VA from January – May 2020 with corresponding time periods in prior years. Methods Data on antibacterial use from 2015 – 2020 were extracted from the VA Corporate Data Warehouse for acute inpatient care units in 84 VA facilities (facilities which provide limited acute inpatient services were excluded). To control for seasonal effects, only data from January to May for each year were included in the analysis. Days of therapy (DOT) per 1000 days-present (DP) were calculated and stratified by CDC-defined antibiotic classes. Results From 2015 – 2019, total antibiotic use from January to May decreased by a mean of 9.1 DOT/1000 DP per year. In contrast, from 2019 to 2020, antibiotic use over the same months increased by 26.4 DOT/1000 DP (Table). Increases were observed in all drug classes except for a decrease in narrow spectrum ß-lactam antibiotics. Total antibiotic DOT in 2020 increased by 27.9 and 7.3 DOT/1000 DP in facilities in the highest and lowest terciles of use in 2019 (Figure). Table – Trends in Yearly Antibiotic Use by CDC Drug Class, 2015 to 2019 versus 2019 to 2020 Figure – Facility Specific Total Antibiotic Use in 2019 and Change in Use from 2019 to 2020 Conclusion We observed a broad increase in antibacterial use during the initial surge of COVID-19 cases in VA facilities that abruptly reversed steady reductions in use over the prior 4 years. The degree to which this increase reflects potentially appropriate use in the setting of increased patient vulnerability and provider uncertainty, inappropriately decreased provider thresholds for initiating or continuing therapy, or stresses on the structure and staffing of antimicrobial stewardship programs requires further study. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of Prior Authorization and Prospective Audit with Feedback for Antimicrobial Stewardship

2014 ◽  
Vol 35 (9) ◽  
pp. 1092-1099 ◽  
Author(s):  
Jimish M. Mehta ◽  
Kevin Haynes ◽  
E. Paul Wileyto ◽  
Jeffrey S. Gerber ◽  
Daniel R. Timko ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Academic Medical Center ◽  
Antimicrobial Use ◽  
Prior Authorization ◽  
Antimicrobial Consumption ◽  
Prospective Audit ◽  
Gram Negative ◽  
Stewardship Program ◽  
Days Of Therapy

(See the commentary by Van Schooneveld and Rupp, on pages1100–1102.)ObjectiveAlthough prior authorization and prospective audit with feedback are both effective antimicrobial stewardship program (ASP) strategies, the relative impact of these approaches remains unclear. We compared these core ASP strategies at an academic medical center.DesignQuasi-experimental study.MethodsWe compared antimicrobial use during the 24 months before and after implementation of an ASP strategy change. The ASP used prior authorization alone during the preintervention period, June 2007 through May 2009. In June 2009, many antimicrobials were unrestricted and prospective audit was implemented for cefepime, piperacillin/tazobactam, and vancomycin, marking the start of the postintervention period, July 2009 through June 2011. All adult inpatients who received more than or equal to 1 dose of an antimicrobial were included. The primary end point was antimicrobial consumption in days of therapy per 1,000 patient-days (DOT/1,000-PD). Secondary end points included length of stay (LOS).ResultsIn total, 55,336 patients were included (29,660 preintervention and 25,676 postintervention). During the preintervention period, both total systemic antimicrobial use (−9.75 DOT/1,000-PD per month) and broad-spectrum anti-gram-negative antimicrobial use (−4.00 DOT/1,000-PD) declined. After the introduction of prospective audit with feedback, however, both total antimicrobial use (+9.65 DOT/1,000-PD per month; P < .001) and broad-spectrum anti-gram-negative antimicrobial use (+4.80 DOT/1,000-PD per month; P < .001) increased significantly. Use of cefepime and piperacillin/tazobactam both significantly increased after the intervention (P = .03). Hospital LOS and LOS after first antimicrobial dose also significantly increased after the intervention (P = .016 and .004, respectively).ConclusionsSignificant increases in antimicrobial consumption and LOS were observed after the change in ASP strategy.Infect Control Hosp Epidemiol 2014;35(9):1092-1099

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

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

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

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&lt; 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 &lt; 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 Evaluation of Initial Outcomes of an Antimicrobial Stewardship Program in a Nonprofit Hospital in Brazil

2020 ◽  
Vol 41 (S1) ◽  
pp. s228-s229
Author(s):  
Adelino Freire Junior ◽  
Fernando Fagundes ◽  
Mozar Castro Neto ◽  
Carine Barbosa ◽  
Thais Alves
Keyword(s):  
Antimicrobial Stewardship ◽  
Polymyxin B ◽  
Hospital Environment ◽  
World Health ◽  
Fourth Generation ◽  
Defined Daily Dose ◽  
Oral Antibiotic ◽  
Microbial Resistance ◽  
Stewardship Program ◽  
Days Of Therapy

Background: One of the main global public health challenges is the fight against microbial resistance, according to the World Health Organization. Inadequate use of antimicrobials is considered one of the main factors related to the phenomenon and is quite common in the hospital environment. Managing the use of antimicrobials in hospitals has become a necessity and has shown positive results in many ways, such as maximizing the effects of pharmacotherapy, preventing the emergence of resistant microorganisms, and reducing healthcare costs. Methods: The prescriptions for patients admitted to a 380-bed nonprofit private hospital in Belo Horizonte, Brazil were monitored from January 1, 2019, to August 31, 2019, with a monthly average of 251 patients followed by the antimicrobial stewardship (AMS) team (1 infectious diseases doctor and 2 clinical pharmacists). Patients selected for follow-up and intervention were those submitted to intravenous, intramuscular, and/or oral antibiotic therapy with the following antimicrobial agents: piperacillin/tazobactam, carbapenem, polymyxin B, tigecycline, vancomycin, teicoplanin, daptomycin, third- and fourth-generation cephalosporins, quinolone, and aminoglycosides. Patients on prophylactic or antimicrobial treatment not mentioned above were excluded from surveillance. Interventions were dose adjustments, drug adjustment by culture results, intravenous to oral treatment switch, and discontinuation of therapy. Results: There were 318 interventions, and 64.82% of the interventions performed by the AMS team were accepted by prescribers. The interventions provided a total savings of BR$ 119,706 (~US$30,000) in direct antimicrobial spending. Correlating the interventions with the defined daily dose (DDD) measurement and comparing data from the same period in 2018, we detected a reductions in the consumption of several antimicrobials: ceftriaxone (25.6%), ciprofloxacin (45.7%), meropenem (34%), piperacillin/tazobactam (12.7%), teicoplanin (18.8%), vancomycin (20.6%), cefepime (23.9%) and polymyxin B (26%). We also detected reductions in days of therapy (DOT) for most of these drugs, such as polymyxin B, with an average reduction of 2 DOT. Conclusions: Reducing antimicrobial use is one of the key strategies for avoiding unnecessary exposure and selective pressure leading to the emergence of resistant microorganisms. The measured data point to a favorable trend in the rational use of antimicrobials in our institution with simple interventions. The results presented were used to reaffirm the importance of the AMS team in our institution. More data on length of stay, indirect costs, reduction of side effects, mortality, and occurrence of microbial resistance should be made.Funding: NoneDisclosures: None

scholarly journals 1018. Using prediction modeling to inform risk-adjustment strategy for hospital antimicrobial use: Can we predict who gets an inpatient antimicrobial?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S358-S359
Author(s):  
Rebekah W Moehring ◽  
Matthew Phelan ◽  
Eric Lofgren ◽  
Alicia Nelson ◽  
Melinda M Neuhauser ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Risk Adjustment ◽  
Model Performance ◽  
Area Under The Curve ◽  
Absolute Error ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Tier 1

Abstract Background Hospital antimicrobial stewardship program (ASP) assessments based on comparisons of antimicrobial use (AU) among multiple hospitals are difficult to interpret without risk-adjustment for patient case-mix. We aimed to determine whether variables of varying complexity, derived retrospectively from the electronic health record (EHR), were predictive of inpatient antimicrobial exposures. Methods We performed a retrospective study of EHR-derived data from adult and pediatric inpatients within the Duke University Health System from October 2015 to September 2017. We used Random Forests machine learning models on two antimicrobial exposure outcomes at the encounter level: binary (ever/never) exposure and days of therapy (DOT). Antimicrobial groups were defined by the NHSN AU Option 2017 baseline. Analyses were stratified by pediatric/adult, location type (ICU/ward), and antimicrobial group. Candidate variables were categorized into four tiers based on feasibility of measurement from the EHR. Tier 1 (easy) included demographics, season, location, while Tier 4 (hard) included all variables from Tier 1–3 and laboratory results, vital signs, and culture data. Data were split into 80/20 training and testing sets to measure model performance using area under the curve (AUC) for the binary outcomes and absolute error for DOT. Results The analysis dataset included 170,294 encounters and 204 candidate variables from three hospitals. A total of 80,190 (47%) encounters had antimicrobial exposure; 64,998 (38%) had 1–6 DOT, and 15,192 (9%) had 7 or greater DOT. Models strongly predicted the binary outcome, with AUCs ranging from 0.70 to 0.95 depending on the stratum (Figure A, B). The addition of more complex variables increased accuracy (Figure Model Tiers 1–4). Model performance varied based on location and antimicrobial group. Models for infrequently used groups performed better (Figure C, D). Models underestimated DOTs of encounters with extremely long lengths of stay. Conclusion Models utilizing EHR-derived variables strongly predicted antimicrobial exposure. Risk-adjustment strategies incorporating measures of patient mix may provide more informative benchmark comparisons for use in Antimicrobial Stewardship Program assessments. Disclosures All authors: No reported disclosures.

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