Impact of an Antimicrobial Stewardship Bloodstream Surveillance Program (BSP) in Hospitalized Patients

Gordon Dow, Tim MacLaggan, Jacques Allard
2017 Open Forum Infectious Diseases  
S488 • OFID 2017:4 (Suppl 1) • Poster Abstracts between groups. There was no difference in the incidence of P = 0.20). Conclusion. The revised VAN dosing protocol for MO patients improved initial TTC attainment and decreased incidence of subtherapeutic TCs compared with current standard of care recommendations with no difference in clinical or safety outcomes. Background. With the rise of antimicrobial resistance, the Centers for Disease Control and Joint Commission have promulgated a national
more » ... nitiative for antimicrobial stewardship programs (ASP). ASP use a multimodal approach such as antibiotic time outs to limit the duration of empiric therapy. Yale New Haven Hospital implemented the use of a 72-hour stop in the electronic medical system (EMR) for empiric PTZ orders. To mitigate the risk of orders inadvertently falling off, a dynamic scoring system was created in the EMR to alert pharmacists of expiring orders in real time. The primary objective of this study was to evaluate the duration of empiric PTZ prior to and after the implementation of the antibiotic time-out. Secondary outcomes included de-escalation, appropriateness of dosing, and safety. Methods. A retrospective cohort study using the EMR was conducted. Cases were defined as adult inpatients who had empiric orders for PTZ without positive cultures. The control group consisted of patients from September to October of 2014, prior to the 72-hour stop. The intervention group included patients from September to October of 2016. Due to the nationwide shortage of PTZ in 2015, this year was excluded in addition to patients with culture documented infections, stem cell/solid organ transplants or febrile neutropenia. Data collected included baseline demographics, renal function, PTZ dose, frequency and duration, indication and final antibiotic selection. Results. Of the 537 random patients reviewed, 300 met inclusion criteria; 150 patients in the control group and 150 patients in the intervention group. The average duration of PTZ decreased from 4 days in the control group to 3 days in the intervention group (P = 0.0013). Overall antibiotic use decreased from 6 days in the control group to 5 days in the intervention group (P = <0.0001). There was an increase in the correct dose and frequency from 35% to 60% of orders in the intervention group compared with the control group (P = 0.004). With the aid of the scoring system, there were no orders that fell off inappropriately in the intervention group. Conclusion. Following the successful implementation of a 72-hour antibiotic timeout we saw a significant decrease in the duration of empiric use, inappropriate dosing and an increase in the rate of antibiotic de-escalation. Session: 168. Stewardship: Improving Outcomes Friday, October 6, 2017: 12:30 PM Background. Bloodstream infections (BSI) in hospitalized patients represent sentinel events characterized by increased mortality. These infections represent an attractive stewardship opportunity because they warrant rapid initiation of empiric antimicrobial therapy, deft transition to directed (gram stain guided) and definitive (susceptibility guided) therapy. Methods. Under a retrospective pre-post study design, a review of patient charts 18 months before and 18 months after initiation of a hospital BSP was carried out. Preintervention, the hospital ward and attending physician were notified of all positive blood cultures (standard of care). Post-intervention an infectious disease pharmacist collaborating with an infectious disease consultant was notified in addition to standard notifications. Results. 226 patients with BSI were identified pre-intervention and 195 patients post-intervention. The two cohorts were similar in baseline characteristics: the most common source of infection was urinary tract (Figure 1); the most common blood stream isolates were E. coli, S. aureus, β-hemolytic streptococci and K. pneumoniae ( Figure 2) ; 71.7% of infections were community acquired; 11.4% were polymicrobial. Empiric therapy was given in 82.6% of patients (16.3% non-susceptible). Directed therapy was given in 54.9% of patients (3.5% non-susceptible). The post-intervention cohort received directed therapy on average 4.36 hours earlier (P = .003), were more likely to receive adequate definitive therapy (99.0% post vs. 79.1% pre, P < .001), and were stepped down to oral therapy earlier (6 days vs. 8 days). Prescription of second generation cephalosporins (0.0% vs. 4.3%, P = .05), quinolones (16.7% vs. 32.7%, P = .005), clindamycin (2.6% vs. 10.3%, P = .03) and aminoglycosides (6.1% vs. 14.6%, P = .05) were decreased for directed therapy post-intervention. Conclusion. A hospital BSP can improve time to first dose of parenteral antimicrobial directed therapy and adequacy of definitive therapy, shorten time from IV to oral step-down and reduce prescription of targeted antimicrobial classes. A BSP can be an effective stewardship strategy in hospitalized patients. Background. The Food and Drug Administration released a safety alert in May 2016 against the use of fluoroquinolones (FQ) in uncomplicated infections including uncomplicated cystitis due to concern for increased risk of disabling and potentially permanent adverse drug effects (ADEs). The aim of the study is to compare the rates of FQ prescriptions for uncomplicated cystitis before and after prescriber education to assess if prescriber education decreases the use of FQs. Methods. This is a single-center, two-phase retrospective chart review comparing a five year pre-intervention and a four month post-intervention periods that evaluated patients seen at UC Irvine's emergency department (ED) or outpatient clinics for uncomplicated cystitis. Adult female, non-pregnant patients 18 years of age or older with the diagnosis of uncomplicated cystitis were included. The treatment guideline for uncomplicated cystitis was developed by the antibiotic stewardship subcommittee with the recommendation to use nitrofurantoin as the first line agent. The infectious diseases pharmacy resident provided educational sessions from December 2016 to January 2017. The primary objective is to evaluate the impact of prescriber education on FQ prescribing rates for uncomplicated cystitis in the ED and outpatient clinics. Secondary objectives include the resistance rates of FQ and trimethoprim/sulfamethoxazole (TMP/SMX) against uropathogens to determine the local resistance rates and ADEs due to FQs. Results. A total of 1056 patients were included in the analysis: 974 in the pre-intervention and 82 in the post-intervention groups. The rate of FQ prescriptions decreased from 32.3% in the pre-intervention group to 13.1% in the post-intervention group (P = 0.0002). The overall resistance rates of uropathogens were 19.3% to FQ and to 34.3% to TMP/SMX. There were 5 (0.5%) ADEs in the pre-intervention and 2 (2.5%) in the post-intervention groups. Conclusion. Prescriber education regarding the appropriate treatment of uncomplicated cystitis and proper use of FQs was effective in reducing the rate of FQ prescriptions in management of uncomplicated cystitis. After prescriber education, the rate of FQ prescriptions decreased by 59%. Disclosures. All authors: No reported disclosures. Effect
doi:10.1093/ofid/ofx163.1257 fatcat:hfhx6oewlfacloegm7wco22w4y