451. Effect of the Addition of Post-Prescription Analysis (PPA) to a Prior Approval (PA) Antimicrobial Stewardship Program (ASP) on Time to Optimal Antimicrobial Therapy in a University Hospital
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Antimicrobial resistance has emerged as a worldwide problem in both the hospital and community settings. The Hospital of the University of Pennsylvania ASP utilizes a restricted formulary with prior approval required for certain antimicrobials. The objective of this study is to compare the time to optimal antimicrobial therapy using the current PA system vs. PA + PPA.
Methods: Using a quasi-experimental study design, all patients with positive blood and urine cultures on a general medicine floor between 11/5/07 and 2/29/08 were identified using TheraDoc® and enrolled in the study. The PA period occurred from 11/5/07-11/23/07 and 2/11/08-2/29/08 and the PA + PPA period occurred from 11/3/08-11/21/08 and 2/9/08-2/27/08. The PA system was continued throughout the study period. PPA consisted of collection of culture results and current antimicrobial therapy as well as evaluation of optimal use by an ASP pharmacist. If the antimicrobial therapy was deemed sub-optimal, the healthcare practitioner was contacted and a more suitable regimen was recommended. Time to optimal therapy was compared between the PA system vs. PA + PPA system.
Results: A total of 282 and 141 patients were identified in the PA group and PA + PPA group respectively. Patients were excluded from evaluation if Infectious Diseases was consulted and/or less than 18 years of age.
n=304PAPA + PPAp-value
Patientsn=216n=88
Total # of blood cultures1524
Total # of urine cultures20766
Length of stay (days)7
(2-87)
10
(2-177)
0.0065
Patients who received antimicrobialsn=83n=58
Treatment duration (days)5
(1-14)
6
(1-14)
0.4902
Patients with possible interventionn=35n=26
Time to optimal antimicrobial therapy in patient with possible intervention (hours)23.5
(0.33-240)
1.95
(0.03-58.8)
0.001

Conclusion: The addition of PPA to an existing PA system significantly decreased the time to optimal antimicrobial therapy which may result in minimizing antimicrobial resistance, limiting the use of unnecessary broad antimicrobial use, and improving patient outcomes. Further studies are needed to evaluate the impact a PA + PPA based system would have on these specific outcomes.
Shawn Binkley, PharmD1, Neil Fishman, MD2, Leanne Gasink, MD3, Amanda Hurst, PharmD3, Kara Mascitti, MD3, Steven Morgan, PharmD3 and  A. L. Hurst, None..
S. Binkley, None..
S. C. Morgan, None..
L. B. Gasink, None..
K. B. Mascitti, None..
N. O. Fishman, None., (1)University of Pennsylvania Medical Center, (2)Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, (3)Hospital of the University of Pennsylvania, Philadelphia, PA