188. Antimicrobial Stewardship for Intraabdominal Infections: Early Impact on Antimicrobial Utilization and Outcomes
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • IDSAposter2011_cIAI_101411.pdf (297.5 kB)
  • Background: 

    In November 2010, we implemented guidelines for empiric therapy of complicated intraabdominal infections (cIAI) in adults.  Due to Enterobacteriaceae resistance to ampicillin sulbactam (ASM) and ciprofloxacin (CP), guidelines recommend cefazolin for mild to moderate cholecystitis, cefoxitin (CX) for mild to moderate extra-biliary cIAI and piperacillin tazobactam (PTZ) or meropenem (MP) ± aminoglycosides and/or ± vancomycin  for severe community-acquired or health-care associated cIAI. Implementation of guidelines was supported by antimicrobial stewardship (AS): PTZ available for order with 72-h audit and feedback, preauthorization required for MP and intravenous (IV) CP.  The objective of this study was to evaluate early impact of described intervention.

    Methods: 

    All patients admitted by general surgery service between 1/1/09-5/1/09, before guidelines implementation (BGI), and 12/1/10-4/1/11, after guidelines implementation (AGI) were included.  Primary endpoint was antimicrobial utilization measured in defined daily doses (DDD)/1000 patient (pt) days per World Health Organization methodology and days of therapy (DOT).  Secondary endpoints included hospital-acquired C. difficile infection (HA-CDI), readmission to surgical service within 30 days and length of stay (LOS).

    Results: 

    304 admissions BGI and 322 AGI were reviewed.  Mean age was 55 years in both groups.  7.6% of patients BGI and 12.4% AGI (p=.04) had an intensive care unit stay during admission.  ASM utilization was highest, mean of 141 DDD/1000 pt days BGI and 130 DDD/1000 pt days AGI (p=ns).  CX utilization increased by 48 DDD/1000 pt days (p=.001) AGI.  IV CP use decreased by 22.6 DDD/1000 pt days (p=.003) AGI.  PTZ utilization increased by 22 DDD/1000 pt days (p=ns).  These trends were consistent with measurements in DOT. HA-CDI rate decreased from 3.3 to 2.6/1000 pt days (p=ns).  30 days readmission rate decreased by 1.9% (p=ns). Mean LOS was 8.4 and 7.9 days (p=ns) BGI and AGI, respectively.

    Conclusion: 

    Implementation of cIAI guidelines combined with AS interventions increased CX and decreased IV CP utilization.  High use of ASM warrants further intervention.  No significant difference was found in HA-CDI rate, 30 days readmission rate and LOS at early stage of evaluation.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Yanina Dubrovskaya, PharmD1, Michael S. Phillips, MD2, Marco Scipione, PharmD1, Sapna A. Mehta, MD3 and John Papadopoulos, PharmD1, (1)Division of Pharmacotherapy, New York University Langone Medical Center, New York, NY, (2)Infection Control and Prevention, New York University Langone Medical Center, New York, NY, (3)New York University School of Medicine, New York, NY

    Disclosures:

    Y. Dubrovskaya, None

    M. S. Phillips, None

    M. Scipione, None

    S. A. Mehta, None

    J. Papadopoulos, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.