969. Evaluation of Antimicrobial Utilization in Early Empiric Protocol-Guided Management of Sepsis: A Single-center Experience
Session: Poster Abstract Session: Stewardship: Epidemiology of Antibiotic Use
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID Week 2013 version 5_v2.pdf (251.2 kB)
  • Background:

    The Surviving Sepsis Campaign (SSC) Early Resuscitation Bundle recommends prompt administration of empiric broad-spectrum antimicrobial therapy with activity against “all likely pathogens”. This study aimed to determine antibiotic (ABX) utilization in the first 48 hours of admission in protocol-guided sepsis patients and analyze for correlates to ABX misuse.

    Methods:

    This study was done in a 670 bed tertiary care teaching hospital. All patients identified for hospital protocol-guided early intervention in sepsis between November 2012 and January 2013 were included. Patient demographic, clinical, number of ABX used in the first 48 hours, change in ABX utilization, ABX days, and microbiological data were obtained on a prospective, observational basis. The data were obtained from hospital database and chart review. Chi-square, wilcoxon, t-test, and fischer’s exact test statistics were used for analysis.

    Results:

    There were 40 patients identified for protocol-guided early sepsis management in the study period. Nineteen (47%) patients were male, 22 (55%) originated from home, 16 (40%) from a nursing home, and 2 (5%) from outpatient dialysis. Within 48 hours of admission, 14 (35%) patients received 4, or more, different ABX and 26 (65%) received less than 4. ABX regimen was changed in 28 (72%) of patients on transfer out of the ED [72% vs. 38%; p=0.003] and was based on definitive microbiological data in 6 (21.4%) patients (p= NS). Mean ABX days during index admission in >=4 ABX vs. <4 ABX groups were 7 and 12.4 days (p=0.003). Thirty-two (32) of 40 (80%) patients had a documented infection. Patient infection source was determined as urinary 8 (20%), respiratory 6 (15%), skin/ soft tissue 4 (10%), bone 5 (12.5%), intra-abdominal 5 (12.5%), and other 4 (10%). Body mass index, age, APACHE Score, hospital & ICU length of stay, and presence of documented infection were not statistically significant in our analysis.

    Conclusion:

    In our hospital, inappropriate ABX utilization in the first 48 hours of protocol-guided sepsis management correlate to increased total ABX utilization and frequency of ABX regimen change in the acute stage of management. Additional antibiotic stewardship efforts should be targeted at early sepsis management.

    Michael Corbett, MD, Infectious Disease, Newark Beth Israel Medical Center, Newark, NJ and Eliahu Bishburg, MD, Newark Beth Israel Medical Center, Newark, NJ

    Disclosures:

    M. Corbett, None

    E. Bishburg, None

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