453. Can an Individualized Educational Stewardship Program Affect Prescribing Patterns and Reduce Antimicrobial Resistance?
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Recent IDSA guidelines for antimicrobial stewardship focus on formulary restriction and preauthorization. Although we have previously demonstrated its efficacy, these retroactive methods are inherently flawed due to reliance on outdated susceptibility data. Educational techniques showing limited benefits suffer from only providing general prescribing recommendations. The objective of this ongoing study is to determine the impact of an individualized educational program incorporating projected resistance trends on prescribing patterns and resistance burden.
Methods: Hospital-specific recommendations were presented to South Jersey Healthcare, a two-hospital system, in the summer of 2008 as part of the VHA “Bugs and Drugs” program, an ongoing collaboration between the Antimicrobial Resistance Management (ARM) Program and VHA. Subsequently, educational programs incorporating these recommendations were instituted. Susceptibility, IV-to-PO conversion and pharmacoeconomic data were collected quarterly following implementation.
Results: Compared with baseline, reduced susceptibility to gram(-) pathogens, including E. coli, K. pneumoniae, and P. aeruginosa, and gram(+) pathogens, including E. faecalis and S. aureus was prevented or reversed for most drugs tested. Susceptibility increased by ≥ 5% for imipenem and piperacillin-tazobactam to P. aeruginosa, whereas imipenem susceptibility to K. pneumoniae decreased by 19%. IV-to-PO conversion improved in the first quarter following program implementation, but returned to baseline thereafter.
Conclusion: Stewardship efforts using individualized educational programs can improve physician prescribing patterns and attenuate worsening susceptibility patterns. This method may be integral to the total stewardship program by promoting resistance prevention in a proactive approach.
Joseph Alessandrini, BSPharm1, John Gums, PharmD, FCCP2, David Kaufman, MD1, Vivien Ng, BSPharm3, Steven Smith, PharmD2 and  S. M. Smith, None..
J. G. Gums, None..
J. Alessandrini, None..
D. Kaufman, None..
V. Ng, None., (1)South Jersey Healthcare, Vineland, NJ, (2)Univ. of Florida, Gainesville, FL, (3)VHA East Coast