190. Antimicrobial Utilization in a Tertiary Care Hospital: Utility of Point Prevalence Survey for Antimicrobial Stewardship
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: In an era of increasing bacterial resistance avoiding unnecessary use of antimicrobial therapy (AT) is critical.  Antimicrobial stewardship programs (ASP) can help minimize adverse consequences of AT.   Point prevalence surveys of antimicrobial utilization (AU) can help identify targets for reducing antimicrobial consumption.

Methods: All adult inpatients (pt) at both campuses (n=2) of a 781 bed tertiary care hospital, were assessed at two separate time points three months apart for AU.  Pts on the bone marrow transplant unit were excluded.  Variables determined included age, sex, number and type of antimicrobials prescribed, stated indication for AT, treatment of health care associated infection (HAI,) opportunities for narrowing or de-escalation of AT, and appropriateness of therapy, ID consult (yes/no), and presence of immunosuppression, among others .

Results: 48% (n=419) of adult inpatients were receiving AT at the time of survey with an average of 1.7 antibacterials/pt.  Indications for AT by patients treated included Clostridium difficile colitis 11% (n=48) community acquired pneumonia 18% (n=75) health care associated pneumonia 20% (n=85), urinary tract infection 20%, bacteremia 6%, and soft tissue infection in 10%.   Thirty nine percent (n=163) of patients were receiving AT for a HAI.  19% of patients were being treated in an ICU.   23% of patients receiving AT were seen by ID consultants.   Nineteen percent of antimicrobials (135 of 694) were unnecessary or overly broad spectrum, after exclusion of prophylactic antibiotics this rose to 22%.   The most common reason for unnecessary AT (29%) was treatment of asymptomatic bacteriuria, followed by failure to de-escalate once cultures returned or overly broad spectrum AT, at 23% and no indication for antimicrobial therapy at 24%.  ID consultation was associated with appropriate antimicrobial therapy at the p< .001 level.

Conclusion: AU is seen in almost half of adult inpatients and almost 20% is unnecessary or overly broad.  Prevention of HAI can help reduce AU.  C Difficile colitis is common in hospitalized pts and largely the result of AU.   Point prevalence surveys of AU are useful for identifying targets to focus ASP


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

Elizabeth Radigan, PharmD, Christy Deeter, PharmD, RN, Iva Zivna, MD and Gail Scully, MD, MPH, UMass Mem. Med. Ctr., Worcester, MA


E. Radigan, None

C. Deeter, None

I. Zivna, None

G. Scully, 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.