157. Assessing the Impact of a Linezolid Clinical Decision Support Tool on Linezolid Use at a Pediatric Academic Medical Center
Session: Poster Abstract Session: Antimicrobial Use in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
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  • Background:

    Implementation of Antimicrobial Stewardship Programs (ASP) can reduce antimicrobial use and decrease cost.  However, human resource limitations may preclude full implementation of a comprehensive ASP.  We evaluated the impact of a linezolid clinical decision support tool integrated into the computerized-provider order entry (CPOE) system on rates of linezolid use and appropriateness of use at a pediatric academic medical center.  The clinical decision support tool outlines indications for linezolid use and recommends Infectious Disease approval if the indications are not met.


    This is a single center, pre- and post-intervention cohort study (n=240 linezolid courses) comparing rates of linezolid use in inpatients before (June 2009-May 2012) and after the implementation of a linezolid clinical decision support tool (June 2012-March 2013). Linezolid rates of use post-intervention were compared to forecasted rates using Winters' exponential smoothing, accounting for seasonality, trend and rate, and fitted to pre-intervention data.  Statistical analysis of pre- and post- intervention data on linezolid rates of use and courses were conducted using the unpaired, two-tailed, Mann-Whitney test.  A subset analysis was performed (June 2011-November 2012, n=85) and descriptively evaluated the intervention’s impact on the appropriateness of linezolid use.


    The intervention analysis demonstrated that the actual rate of linezolid use (1.44 linezolid days/1000 patients days) post-intervention exited the lower bound of the forecasted 95% confidence interval (95% CI 3.46-61.6 linezolid days/1000 patient days) in January 2013.  The actual use remained significantly less than the predicted use for the remainder of the analysis.  Rates of linezolid use (11.57 to 4.81 linezolid days/1000 patient days, p<0.001) and total linezolid courses (5 to 3 courses/month, p=0.014) were significantly decreased in June-March post-intervention as compared to the same interval pre-intervention.  The percentage of linezolid courses defined as appropriate increased from 44% to 56% from the pre- to the post-intervention period.


    Clinical decision support tools may be an effective intervention to reduce unnecessary use of targeted antimicrobials and can be an important component of an ASP.

    Alexander Kay, MD1, Jenny Li, PharmD2, John Tamaresis, PhD, MS1, Laurale Dyner, MD1, Roshni Mathew, MD1, Natalie Pageler, MD1, Betty Lee, PharmD2 and Kathleen Gutierrez, MD1, (1)Pediatrics, Stanford University School of Medicine, Stanford, CA, (2)Department of Pharmacy, Lucile Packard Children's Hospital, Stanford, CA


    A. Kay, None

    J. Li, None

    J. Tamaresis, None

    L. Dyner, None

    R. Mathew, None

    N. Pageler, None

    B. Lee, None

    K. Gutierrez, 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.