186. Impact of an antimicrobial stewardship program using a computerized surveillance system maximizing results with limited resources
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: Antimicrobial (ATM) stewardship programs can be cost-effective, improve care and control resistance. Identifying improvable prescriptions is a key component of these programs but requires intensive data management. A computerized surveillance system is the best option to perform this task. This study aims to evaluate the impact of a locally-developed system called APSS.

Methods: All hospitalized adults receiving ATM from 01/01/2009 to 03/10/2011 at the Centre Hospitalier Universitaire de Sherbrooke, a 686-bed academic center located in Québec, Canada, were included. APSS was implanted on 08/23/2010, and was used on an average of 15 hrs/week by a pharmacist. A validated algorithm reviewed asynchronously every ATM doses for: i) dosage/interval adjustment (for creatinine clearance, ATM serum dosage and weight), ii) coherence with microbiology results, iii) optimal duration and route of administration. Student’s t-test was used to compare means between the pre- and post-intervention periods. No co-intervention aimed in reducing/optimizing ATM was initiated during or prior to the intervention.

Results: The intervention period included 133 082 patients-days of hospitalisation and 21 633 ATM-days, for an average of 163 ATM-days per 1000 hospitalisations-days (RAU, ratio of ATM utilization). A significant reduction  was observed in comparison to the 174 RAU of the 30 preceding weeks (p=0.001). ATM reduction was associated with a discount of 336$/1000 hospitalization days. A total of 688 recommendations were made, and 585 (85%) were accepted by the prescribing physician. The most common interventions were: dosage/intervals adjustment 217 (37%), termination of treatment 134 (23%) and intravenous to oral switch 130 (22%). Direct savings in ATM cost of 66 000$ were observed compared to the level of ATM consumption of the pre-intervention period. Projecting the constant increase in ATM costs observed in our center raises these savings 94 000$.

Conclusion: APSS maximized the pharmacists' workload management, allowing monitoring of all ATM on two geographically distinct sites. For each hour of work dedicated to APSS, our hospital saved 147 to 209$ in direct costs. This proves the cost-effectiveness of APSS in a context of limited resources.


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

Vincent Nault, B.Sc.1, Mathieu Beaudoin, M.Sc.1, Jacques Pépin, M.D.1, Julie Perron, M.Sc.2 and Louis Valiquette, M.D.1, (1)Université de Sherbrooke, Sherbrooke, QC, Canada, (2)Pharmacy, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

Disclosures:

V. Nault, None

M. Beaudoin, None

J. Pépin, Wyeth: Scientific Advisor and Speaker's Bureau, Salary
Merck: Scientific Advisor and Speaker's Bureau, Salary
Pfizer: Scientific Advisor, Salary
Acambis: Scientific Advisor, Salary
Iroko: Scientific Advisor, Salary
The Medicine Company: Scientific Advisor, Salary
Ortho-Janssens: Scientific Advisor, Salary

J. Perron, None

L. Valiquette, Pfizer Canada: Investigator, Scientific Advisor and Speaker's Bureau, Research grant, Research support and Salary
Actelion: DMBC, Salary
Trius: Investigator, Research support
Cempra: Investigator, Research support
Polymedix: Investigator, Research support
Merck: Investigator, Research support
Cubist: Investigator, Research support

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.