178. A Community Hospital Computerized Physician Order Entry Antimicrobial Stewardship Program Focused on Linezolid, is Enhanced by the Involvement of an Infectious Disease Specialist
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • IDSA 39152 BWposter 178.pdf (612.7 kB)
  • Background: Antimicrobial stewardship programs in the community setting, utilize strategies such as prospective audits with intervention and feedback, formulary restriction, and pre-authorization. The goal of this study is to determine the impact of a computerized physician order entry antimicrobial stewardship program (CPOE-ASP) initiated in the presence of an Infectious Disease (ID) specialist.

    Methods: A CPOE-ASP focused on linezolid utilization, was implemented in two suburban community hospitals in metropolitan Phoenix over a 16 month period. The 214-bed facility (Hospital A) incorporated an ID physician to direct the ASP while the 165-bed facility (Hospital B) ASP operated in the absence of an ID physician. Utilization was prospectively monitored using monthly hospital pharmacy purchasing data  to obtain the defined daily dose (DDD) per 1000 patient-days as well as total expenditures for linezolid use. Medication utilization evaluation (MUE) was performed to assess the percentage of inappropriate of linezolid orders. Mann-Whitney U and the Fisher Exact tests were used for statistical analysis when appropriate

    Results: Significant decreases in linezolid use were observed in Hospital A (Figure 1) in the presence of an ID physician leading the program (from 44 to 28 DDD per 1000 patient-days, p<0.03) and with the subsequent introduction of a CPOE-ASP (from 28 to 7 DDD/1000 patient days, p<0.001). In Hospital B, the low linezolid use did not improve with the initiation of CPOE-ASP (from 0.78 to 1.03 DDD/1000 patient days). After initiating a CPOE-ASP, Hospital A's total expenditures for linezolid decreased, resulting in cost savings well over $630,000 over 16 months.  Though the MUE of both hospitals showed a significant decrease in inappropriate linezolid orders after the initiation of a CPOE-ASP, the drop was more dramatic in Hospital A (from 77% to 11%, p<0.0003) compared to Hospital B (60% to 36%, p<0.007).

    Conclusion: A CPOE-ASP initiated in the presence of an ID physician, significantly impacts the prescribing habits of linezolid in the community hospital setting.


    Subject Category: A. Antimicrobial agents and Resistance

    John Leander Po, MD, PhD, Section of Infectious Diseases, Banner Estrella medical center, Phoenix, AZ, Bao Nguyen, PharmD, BCPS, Banner Estrella Medical Center, Phoenix, AZ, Mary Martin, PharmD, BANNER GOOD SAMARITAN MEDICAL CENTER, Phoenix, AZ and Brianne Hansen, PharmD, Banner Gateway Medical Center, Gilbert, AZ

    Disclosures:

    J. L. Po, Cubist: Speaker's Bureau, Speaker honorarium

    B. Nguyen, None

    M. Martin, None

    B. Hansen, 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.