238. Impact of a Doripenem Formulary Restriction Protocol
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1

Background: Due to increasing rates of multi-drug resistant infections we employed a formulary restriction protocol for doripenem (DOR) upon formulary addition, as an antimicrobial stewardship program (ASP) intervention. DOR 4 hour extended infusion replaced imipenem 30 minute infusion, a non-restricted drug, to enhance carbapenem activity against increasingly resistant Gram negative pathogens. The impact of a formulary restriction protocol is described.

Methods: A formulary restriction protocol was created by the ASP. Evidence-based DOR use criteria, an education program, an ASP pager, and a call schedule were developed.  Pager hours were 8am-10pm daily. Prescribing clinicians paged ASP for DOR approval. If the ASP member agreed that DOR was appropriate, a code was given to the prescribing clinician who entered it in the computerized physician order entry system. If DOR was not considered appropriate, alternative therapy was recommended. The evaluation period was October 4, 2010-April 30, 2011. Data collection included time to return page, call length, patient location, attending physician, ordering physician, hospital service, indication, approval code, infectious diseases (ID) consult, order status, medication recommendations, and prior imipenem use.

Results: There were 328 pages (265 patients) over the study period. Mean time to return a page during pager hours was 2.7 minutes; mean call length was 4.2 minutes; 91.5% of orders were approved. The hospital service most frequently requesting DOR was MICU (27%). Among cases, 48% were being followed by ID at the time of the page or had an ID consult ordered. Mean DOR use was significantly lower than prior mean imipenem use (11 antimicrobial days/1000 patient days vs 27 antimicrobial days/1000 patient days; p=0.0008) (Figure).

Conclusion: The restriction protocol decreased mean anti-pseudomonal carbapenem use by half with no evidence of delays in time to place a DOR order indicating a positive impact by ASP on optimizing antimicrobial use and directing prescribing trends. Future directions include consideration of additional drugs to formulary restriction with review of patient outcomes.

Figure. Antimicrobial days/1000 patient days, Imipenem and Doripenem, January 2010-April 2011

Subject Category: J. Clinical practice issues

Jessica E. West, MSPH1, Erica E. Reed, PharmD, BCPS2, Jeremy Taylor, PharmD, BCPS2 and Kurt Stevenson, MD, MPH1, (1)Infectious Diseases, The Ohio State University Medical Center, Columbus, OH, (2)Pharmacy, The Ohio State University Medical Center, Columbus, OH


J. E. West, None

E. E. Reed, None

J. Taylor, None

K. Stevenson, 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.