1044. Antimicrobial use associated with the implementation of fever and neutropenia clinical practice guidelines in cancer patients
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

The main goal of the implementation of clinical practice guidelines (CPG) is to ensure high-quality of care by improving efficiency, improving patient safety, and reducing unnecessary hospital costs.  Moreover, institutional antimicrobial stewardship programs are increasingly facilitating multidisciplinary development of evidence-based practice guidelines that incorporate local microbiology and resistance patterns.  We describe the trend of antibiotic use before and after the implementation of fever and neutropenia (F&N) CPG at a children’s teaching hospital. 

Methods:

The study was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt, a 260 bed tertiary care pediatric hospital, with a 19 bed myelosuppression unit.  In 2011, a multidisciplinary team of oncologists and infectious diseases physicians developed institutional F&N CPG targeting antibiotic use Antifungal recommendations were not included.  Trends of antimicrobial use among hospitalized oncology and Hematopoietic Stem-Cell Transplant (HSCT) patients, measured as days of therapy (DoT), 17 months before (01/01/10 - 05/31/11) and after (06/01/11-10/30/12) the intervention are reported.  Antimicrobial use is normalized as DoT/1000 Patient-days (PD)/year.  Trends of monthly antimicrobial use were analyzed using regression analysis (IBM SPSS statistics v. 20).

Results:

After the implementation of the F&N CPG, the overall monthly antimicrobial use among oncology and HSCT patients declined from 1135 DoTs/1000 PD to 969 DoT/1000PD (-15%; p = .06).  The use of antibiotics decreased from a monthly average of 884 DoT/1000PD to 729 DoT/1000PD (-18%; p <.01).  A greater impact was noted for vancomycin (154.5 DoT/1000PD to 104.5 DoT/1000PD; -32%; p < .001) and levofloxacin (90 DoT/1000PD to 47 DoT/1000PD; -48%; p < .01).  No significant changes were noted for meropenem use (55 DoT/1000PD to 56 DoT/1000PD; 2%; p =.9).  Cefepime use increased from 276 DoT/1000PD to 292 DoT/1000PD; 6%; p <.01).  Antifungal use did not change significantly (161 DoT/1000PD to 165 DoT/1000PD; 3%; p=.3)

Conclusion:

Development of multidisciplinary CPG and clinical pathways with collaboration between infectious diseases and other specialty services can lead to statistically significant reduction in antibiotic use among selected patient populations.

Jessica Gillon, PharmD1, Adam Esbenshade, MD2, Debra Friedman, MD2 and M. Cecilia Di Pentima, MD, MPH3, (1)Pharmacy, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, (2)Vanderbilt University, Nashville, TN, (3)Pediatrics, Vanderbilt University, Nashville, TN

Disclosures:

J. Gillon, None

A. Esbenshade, None

D. Friedman, None

M. C. Di Pentima, None

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