1059. Use of Educational Strategies to Reduce Inappropriate Antibiotic Consumption: Experience in an Academic Tertiary-Care Center in Mexico
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • POST STEWARDSHIP IDW13.pdf (1.3 MB)
  • Background: Educational strategies such as clinical pathways (CP) are less validated as a means to reduce inappropriate antibiotic usage. In our hospital, a 200 bed, academic tertiary-care center, all antibiotic prescription is daily pre-authorized by an Infectious Diseases specialist. We decided to add another strategy to our infection control program. A CP consistent with international guidelines and adapted to local resources was developed and evaluated.

    Methods: The CP was implemented in June 2011. It was designed to guide antimicrobial decisions such as timely interruption of antibiotics or length of therapy. It was released as a poster, distributed in every hospital area, and presented to the Internal Medicine, Critical Care and Surgery services. The guidelines were reinforced every two months through oral presentations. The DDD/1000 patient-days for carbapenems, piperacillin-tazobactam and vancomycin was measured before and after the CP implementation, according to the pharmacy information. We also searched the Microbiology Laboratory database to identify positive blood cultures for extensively-drug resistant Pseudomonas aeruginosa (XDRPA) and Acinetobacter baumanii (XDRAB), extended-spectrum beta lactamase Klebsiella pneumoniae (ESBLKP), vancomycin-resistant Enterococcus faecium (VREF) and methicillin-resistant Staphylococcus aureus (MRSA) from hospitalized patients.


    Results: After the CP was distributed, we observed a reduction on the DDD/1000 patient-days for carbapenems (245.47 vs. 228.25), piperacillin-tazobactam (221.85 vs. 204.41) and vancomycin (170.37 vs. 156.60), for the first semester of 2011 and 2012, respectively. There was a sustained reduction on the rate of positive blood cultures of XDRAB/1000 patient-days (0.192, 0.157, 0.067 and 0.064), from the first through the second semester of 2011, and the first and second semester of 2012, (r= -0.048, p=0.05). There was a similar reduction on positive blood cultures of ESBLKP/1000 patient-days (0.224, 0.157, 0.100, 0), for the same time-frame (r=-0.07, p=0.009). Other pathogens showed a non-significant reduction trend.

    Conclusion: The addition of a CP to reinforce antimicrobial stewardship was an effective strategy to reduce extended-spectrum antibiotic use, and resulted in less frequent isolation of XDR-gram negatives.

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    María Eugenia Pérez Aguinaga, MD1, Marisol Manríquez Reyes, MD2, Carlos Agudelo Restrepo, MD, MSc3, Alethse De la Torre Rosas, MD4, Ma. De Lourdes Guerrero Almeida, MD, MSc1, Elia Criollo Mora, PhC5, Alejandro Macías Hernández, MD MS6, Arturo Galindo Fraga, MD MSc6 and Guillermo Ruiz Palacios, MD PhD6, (1)Infectious Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico, (2)Infectious Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, México City, Mexico, (3)Infectious Diseases, Clínica Universitaria Universidad Pontificia Bolivariana, Medellín, Colombia, (4)National Institute of Medical Sciences and Nutrition, Mexico City, Mexico, (5)Department of Pharmacy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico, (6)National Institute of Medical Sciences and Nutrition, Mexico, Mexico

    Disclosures:

    M. E. Pérez Aguinaga, None

    M. Manríquez Reyes, None

    C. Agudelo Restrepo, None

    A. De la Torre Rosas, None

    M. D. L. Guerrero Almeida, None

    E. Criollo Mora, None

    A. Macías Hernández, None

    A. Galindo Fraga, None

    G. Ruiz Palacios, None

    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.