225. Analysis of Antimicrobial Therapy in an Intensive Care Unit in the Absence of an Antimicrobial Management Team
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1
Background: Initiating and maintaining Antimicrobial Stewardship Programs (ASP) is dependent on the ability to analyze data that describe antimicrobial use to identify quality gaps. Wide variations in intra-institutional antimicrobial prescribing habits support conducting analyses at the unit-specific level. Clinical practice guidelines (CPG) can help bring consistent antimicrobial care to routine practice and should be the basis for quality assessments. This analysis assesses adherence to CPG in a Medical Intensive Care Unit (MICU) in the absence of an active ASP, in order to determine opportunities for ASP led interventions. Methods: Retrospective study performed in a MICU within an 852-bed academic medical center. All patients initiated on antimicrobials in the MICU, between June and September 2010, were evaluated. Adherence was assessed based on IDSA endorsed or developed CPG for the site of infection. Parameters evaluated were diagnostic data, empiric selection, de-escalation (i.e., narrowing or discontinuing antimicrobial therapy), dosing, and duration of treatment (DOT). Results: 95 patients receiving antimicrobials for suspected or documented infections were evaluated. The most common infections were healthcare-associated (35%) or community-acquired pneumonia (18%), sepsis (23%), urinary tract infections (6%), and bloodstream infections (5%). The highest adherence rates were selection of the appropriate dose (87%), obtaining minimum baseline diagnostic data (83%), and appropriate antimicrobial selection (72%). Meanwhile, adherence rates to other parameters [e.g., completion of de-escalation (48%) and appropriate DOT (59%)] were suboptimal. Conclusion: This study demonstrated that adherence to CPG-based parameters in our MICU varied considerably, provides baseline information on antimicrobial prescribing practices, and reveals opportunities for improving antimicrobial delivery. The next step will be implementing strategies aimed at bridging gaps between CPG recommendations and daily practice. Particularly, de-escalation practices within our MICU require attention. Developing de-escalation and DOT policies could promote consistency amongst prescribers and minimize overuse of antimicrobials.

Subject Category: J. Clinical practice issues

David Guervil, PharmD1, Kenneth Klinker, PharmD1, Samuel Borgert, RPh1 and Reuben Ramphal, MD2, (1)Shands at the University of Florida, Gainesville, FL, (2)University of Florida College of Medicine, Gainesville, FL

Disclosures:

D. Guervil, None

K. Klinker, None

S. Borgert, None

R. Ramphal, None

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