181. Feasibility and Acceptability of an Audit and Feedback Method of Antibiotic Stewardship: A Pilot Study
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: Our Antimicrobial Stewardship Program (ASP) (1,200 bed multi-campus facility) has used antibiotic restrictions to control use.   A case-control study in our institution showed that piperacillin/tazobactam (PT) had the strongest association with C. difficile colitis (OR=5.3, p < .001).  The objective of this study is to evaluate ASP interventions using audit/feedback to de-escalate patients on PT.

Methods: We conducted a retrospective review of PT over 4 months, followed by a prospective pilot study of PT de-escalation on the adult medical service.  PT orders (> 2 days of PT) and charts were audited 2 days/week for 2 months by an ID fellow with the ASP director.  Recommendations were conveyed verbally and included narrowing the spectrum and number of antibiotics, limiting the treatment duration, stop antibiotics, or obtain ID consultation.  Follow-up for adherence and outcome was ascertained.

Results:

Review of PT Usage:  317 patients received a mean duration of 5 days (range 1-18) of PT monthly (17.5 kg PT per month, one campus).  Medicine service used the most PT (61%), most of which was empiric [most common syndromes: pneumonia (20%), sepsis (20%), and unknown cause of illness (16%)].  Although many initial regimens were appropriate (55%), reassessment and de-escalation was lacking. 

Pilot Audit and Feedback: 115 charts were audited over 2 months (Table 1).  Adherence to our recommendation was 79%. 

 Table 1- Outcomes for Audit and Feedback Pilot

Recommendation

# cases (%) of 115

De-escalate

45 (39)

Stop antibiotics

17 (15)

Continue

15 (13)

Obtain ID consult

19 (16.5)

No recommendation

19 (16.5) not enough info, already changed, other

 

Conclusion: Broad-spectrum antibiotics may be appropriate initially, but opportunity for reassessment and de-escalation is often missed.  Our study shows possible intervention in >50% of cases with 79% acceptance.  Verbal interactions/case discussions with prescribers were welcomed.  Analysis of outcomes (e.g, readmits, C. difficile, superinfection) and expansion of this intervention is ongoing, but our pilot suggests that audit/feedback strategies are feasible and can provide education in a large urban teaching facility.  


Subject Category: A. Antimicrobial agents and Resistance

Claire Brown, MD1,2, Philip Chung, PharmD1,2, Yi Guo, PharmD1,2, Shakara Brown, MPH1 and Belinda Ostrowsky, MD, MPH1,2, (1)Montefiore Medical Center, Bronx, NY, (2)Albert Einstein College of Medicine, Bronx, NY

Disclosures:

C. Brown, None

P. Chung, None

Y. Guo, None

S. Brown, None

B. Ostrowsky, 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.