1016. Impact of an Antimicrobial Stewardship Program (ASP) on Antimicrobial Usage and Incidence of Clostridium difficile Infections (CDI) at a Teaching Hospital
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA ASP-c.diff poster 2013.Anthone.pdf (197.3 kB)
  • Background: Because few reports describe ASP impact on CDI rates, a comparison was performed on the incidence of new onset CDIs at our hospital (>48 h after admission) before and after initiation of an ASP.  We also sought to determine if our ASP affected the number of vancomycin levels performed and pharmacy antimicrobial costs.

    Methods: The ASP team (clinical pharmacist, infectious diseases [ID] attending, ID fellow) established criteria for targeted intervention. A hospital software program (Sentri7) was used to identify patients receiving selected antimicrobials. The ASP team reviewed the medical records and microbiology lab findings for each identified patient.  If intervention was warranted, the ASP team contacted the prescriber to convey its recommendation(s). Data was collected prospectively during ASP implementation (ASP) (Oct 2011-Sept 2012) and retrospectively for the pre-ASP comparative interval (pre-ASP) (Oct 2010-Sept 2011).  There were no differences in infection control policies or procedures between the two study intervals.  This project was IRB approved. Data was analyzed using SPSS-PC (ver. 20, SPSS Chicago, IL).

    Results: During ASP implementation, 579/634 recommended interventions (91%) were accepted.  Of the accepted changes, IV to PO (48%), de-escalation (23%), bug-drug mismatch (12%), and discontinuing duplicate therapy (6%), accounted for the majority of recommendations.  Acceptance rates did not differ significantly among medicine, surgery, OB-GYN, or family medicine providers.  The most common recommendation rejected was for de-escalation.  Rates per 1000 patient days (pre-ASP vs. ASP) significantly declined for nosocomial CDI cases (0.78 vs. 0.25; p=0.029).  In addition, the rate per 1000 patient days of vancomycin level determinations also decreased (23.48 vs. 21.2; p>0.05).  Cost savings for reduced antimicrobial usage and fewer vancomycin levels totaled $179,000.  No difference in the number of hospital admissions pre-ASP compared to ASP was found.

    Conclusion: ASP teams can achieve high acceptance rates for suggested antimicrobial changes made to prescribing hospital physicians.  This reduces the incidence of nosocomial CDIs, the use of expensive and/or unneeded diagnostic tests, and the cost of treating infections in hospitalized patients.

    Jennifer Anthone, PharmD1, Renuga Vivekanandan, MD2,3, Cezarina Mindru, MD2,3, Karim Ali, MD2,3, Mir Ali, MD2,3, Edward Horowitz, MD2,3, Marvin Bittner, MD2,3, Gary Gorby, MD2,3, Chris Destache, PharmD2 and Laurel Preheim, MD2,3, (1)Pharmacy, Alegent Creighton Health - Creighton University Medical Center, Omaha, NE, (2)Medicine, Creighton University School of Medicine, Omaha, NE, (3)Infectious Diseases, Alegent Creighton Health - Creighton University Medical Center, Omaha, NE


    J. Anthone, None

    R. Vivekanandan, None

    C. Mindru, None

    K. Ali, None

    M. Ali, None

    E. Horowitz, None

    M. Bittner, None

    G. Gorby, None

    C. Destache, Forrest Pharmaceuticals: Grant Investigator, Research support
    Cubist Pharmaceuticals, Inc.: Grant Investigator, Research support

    L. Preheim, None

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