1000. Impact of an Antimicrobial Stewardship Program (ASP) on Antimicrobial Use and Infectious Disease (ID) Consultation
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • IDweek_2013_VA ASP_FINAL.pdf (613.4 kB)
  • Background: ASPs are used as key strategies to limit the spread of antimicrobial resistance through appropriate antimicrobial utilization practices. However, some institutions may be hesitant to implement an ASP due to a potential loss of ID physician consultations.

    Methods: Our ASP team of attending and fellow ID physicians, a clinical ID pharmacist and fellow, and pharmacy residents and students prospectively audited all inpatient antimicrobial use (IV and PO) daily. Pharmacy trainees reviewed patient (pt) charts and identified interventions (INTs) which were then discussed with the team. Verbal communication and/or written notes were used to recommend INTs. The pharmacy fellow followed-up on INTs and documented results. Outcomes, including antibiotic (abx) use, ID consults and abx costs, were compared between the pre-intervention (PIP; Sept 2010-Feb 2011) and intervention period (IP, Sept 2012-Feb 2013). The Wilcoxon signed rank test was used to compare costs, overall abx (IV and PO), IV abx, and PO abx use as days of therapy (DOT) and defined daily doses (DDD)/1000pt days (PD).

    Results: During the IP, 539 pt records were reviewed. These pts were 23 - 89 yrs (mean 69.5± 13.1), 96.5% white, and 92.0% male. The majority of pts were treated for PNA (29.1%), UTIs (19.1%), or SSSIs (19.3%). There were 273 INTs made, with an acceptance rate of 76.2% (13.2% unknown if team received INT or were not applicable ie. pt discharged/abx changed). Overall abx use decreased significantly from 30,147 to 25,980 gms (p=0.007) and from 862.5 to 761.5 DDD/1000 PD (p=0.048). The decline in DOT/ 1000 PD, from 708.4 to 644.5, a change of 63.9 DOT/1000 PD, was not statistically significant. IV abx use decreased by 70.9 DOT/1000 PD (p<0.001), while PO abx use had a non significant increase of 3.5 DOT/1000 PD. For IV abx, vancomycin, piperacillin/tazobactam, and moxifloxacin use decreased by 12.5, 7.2, and 10.5 DOT/1000 PD, while ceftriaxone and ampicillin/sulbactam use increased by 9.4 and 7.6 DOT/1000 PD, respectively. Total abx costs decreased $88,407 from the PIP to IP, from $37.3 to $30.7/PD (p=0.005). ID consults/1000 PD increased 22.3%, from 7.6 to 9.8.

    Conclusion: Implementing an ASP with prospective audit and feedback was associated with significant reductions in abx use and pharmacy costs, while increasing ID consults compared to the pre-intervention period.

    Haley Morrill, PharmD1,2, Aisling Caffrey, MS, PhD1,2, Russell J. Mcculloh, MD3,4, Dennis Riley, RPh5, Patricia Cristofaro, MD3,4, Melissa Gaitanis, MD3,4 and Kerry Laplante, PharmD1,2,4, (1)College of Pharmacy, University of Rhode Island, Kingston, RI, (2)Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, (3)Infectious Diseases, Providence Veterans Affairs Medical Center, Providence, RI, (4)Warren Alpert School of Medicine, Brown University, Providence, RI, (5)Pharmacy, Providence Veterans Affairs Medical Center, Providence, RI


    H. Morrill, None

    A. Caffrey, Pfizer Pharmaceuticals, Inc: Grant Investigator, Educational grant
    Department of Veterans Affairs Role: Employee,

    R. J. Mcculloh, None

    D. Riley, None

    P. Cristofaro, None

    M. Gaitanis, None

    K. Laplante, Pfizer Pharmaceuticals, Inc: Investigator, Educational grant
    Cubist Pharmaceuticals, Inc.: Consultant and Speaker's Bureau, Consulting fee
    Forrest Laboratories : Consultant, Consulting fee
    Astellas Pharma US, Inc: Consultant, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.