997. Effect Of A Collaborative Infectious Disease and Critical Care Antimicrobial Stewardship Intervention - Can It Last?
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA Poster.pdf (221.8 kB)
  • Background:  We have previously demonstrated benefit from daily collaboration between Infectious Disease (ID) and Critical Care Medicine (CCM) on guideline adherence and antibiotic expenditure. (Crit Care Med 2013. In press) We assessed the impact of this intervention when the ID fellow no longer rounded daily in the medical intensive care unit (MICU).  

    Methods:  A retrospective post-intervention review of 89 charts was then done three months (N=47) and six months (N=42) in the same 24-bed MICU at an 861-bed tertiary care, university teaching hospital.  Data included demographics, severity indicators (APACHE II), admitting pathology, MICU infection, clinical outcomes (antibiotic use, mechanical ventilation days (MVD), MICU length of stay (LOS)) and appropriateness of therapy based on current guidelines. Clinical infections included community-acquired pneumonias (CAP), health-care associated pneumonias (HCAP), intra-abdominal and urinary tract infections (UTI). Statistical analysis was done via non-paired t-test.

    Results: In the three-month (3-PI) and six-month post-intervention (6-PI), there were no significant differences in age, APACHE II score, MVD, LOS or average days of therapy. The number of therapies not in accordance with guidelines was similar (5 in the intervention, 5 in the 3-PI, 8 in the 6-PI). The incidence of common MICU infections, including HCAP, CAP, and UTI were similar. There were no statistically significant differences in the mean use of extended-spectrum penicillins (3.0 in the intervention, 3.6 in the 3-PI, 2.8 in the 6-PI) and cephalosporins (1.6 in the intervention, 1.6 in the 3-PI, 1.5 in the 6-PI). While there were significant differences in vancomycin usage after 3 months (3.1 vs. 4.3 [P=0.04]), this finding was not seen 6-months after the intervention (3.1 vs. 3.4 [P=0.56]). There were differences in carbapenems after 6 months (0.97 vs. 2.2 [P=0.01]), but not after 3-months (0.97 vs. 1.1 [P=0.77]).

    Conclusion:  The overuse of antibiotics remains an increasing burden to healthcare cost and clinical outcome. Daily collaboration between ID and CCM can have a lasting effect on adherence to guidelines and antimicrobial expenditure, even six months after the intervention.

    Kaushal Shah, M.D., Ramzy Rimawi, MD and Paul Cook, MD, Infectious Diseases, East Carolina University, Greenville, NC


    K. Shah, None

    R. Rimawi, None

    P. Cook, None

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