454. Antimicrobial Stewardship Program (ASP): Five Year Evaluation of Interventions and Outcomes at a Pediatric Teaching Hospital
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
ASPs are an effective strategy to improve patient outcome, minimize AM resistance and reduce hospital costs
Methods: In April 2004, active surveillance of 15-targeted AM (amikacin, amphotericin B, cefepime-CEF, ceftazidime-CEFT, ceftriaxone, ciprofloxacin, fluconazole, levofloxacin, linezolid, meropenem, piperacillin-tazobactam-PIPT, ticarcillin-clavulinc acid-TIC, tobramycin, vancomycin, and voriconazole) was implemented. AMs were selected based on spectrum of activity and cost. Indications for AM use were incorporated as mandatory fields using the Institution computerized information system. CEFT and TIC were removed from the formulary and CEF and PIPT were added. In 2005 surveillance was extended to all AM. An automated report of AM, patient and microbiology data was reviewed by ID pharmacist and specialist. Interventions were addressed with health care provider. AM use defined by the # of doses administered / 1000 patient days / year (DA/1000 PD/Y) was measured before and after implementation
Results: From 2003, prior to the implementation of the ASP, AM use declined from 3088 DA/1000 PD/Y to 1838 DA/1000 PD/2008-2009; P=<0.001. Targeted-AM use declined 13.6% (1250 DA/1000 PD/Y to 1080 DA/1000 PD/Y, P<0.01). Of these, targeted antibiotics declined from 1084 DA/1000 PD/year to 911DA/1000 PD/Y(P=<0.01). Targeted-antifugal use minimally increased from 166 DA/1000 PD/Yto 169 DA/1000 PD/Y, despite a significant raised in BMT patients. The lowest rate of targeted AM utilization was achieved 3 years into the program (988 DA/1000 PD/Y). Utilization of non-targeted AM dropped from 1839 DA/1000 PD/Y to 752 DA/1000 PD/Y; P <0.001
We performed 65 interventions/1000 PD including dose adjustment (28/1000 PD) and modification of AM therapy (24/1000 PD) Rejection rates dropped by 50%. AM susceptibilities remained stable
Main outcomes associated with ASP interventions included enhancement of AM therapy and prevention of ADR and AM errors
Conclusions: Implemention of ASP with real time feedback to prescribers lead to the reduction of targeted and non-targeted AM use, enhancement of AM therapy and increasing rates of acceptance
Shannon Chan, Pharm D, Alfred I. duPont Hospital for Children, Wilmington, DE, M. Cecilia Di Pentima, MD, MPH, Thomas Jefferson University, Alfred I. duPont Hospital for Children, Wilmington, DE and  M. Di Pentima, None..
S. Chan, None.