Program Schedule

206
Implementing an Antimicrobial Stewardship Program

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • 2014 ID Week ASP Poster.pdf (427.0 kB)
  • Background: The antimicrobial stewardship program (ASP) at Providence Saint John’s Health Center was implemented in June, 2013. The program was developed in three phases. Each phase was three months duration.

    Methods: The ASP tracked the following interventions in each phase: IV to PO, dose change, redundancy, de-escalation (of Daptomycin, Ertapenem, and Teflaro), inappropriate antibiotic combination, drug/bug mismatch, positive culture with no coverage, and duration.

    Results: In phase 1 (Jul-Sep 2013), 275 interventions were made in 1109 eligible patients and 232 (84%) interventions were accepted in dose change, IV to PO, and positive culture with no coverage. Of the 16% of interventions which were not accepted, the major categories were: redundancy and restricted antibiotics. In phase 2 (Oct-Dec 2013), 215 interventions were made in 1032 eligible patients and 194 (90%) interventions were accepted in dose change, IV to PO, and positive culture with no coverage. Of the 10% of interventions that were not accepted, the major categories were: redundancy and restricted antibiotics. The most frequently made interventions in phases 1 and 2 were redundancy and de-escalation. In phase 3 (Jan-March 2014), 216 interventions were made in 1248 eligible patients and 197 (91%) interventions were accepted in dose change, IV to PO, de-escalation, restricted antibiotics and drug/bug mismatch. Of the 9% of interventions that were not accepted, the major categories were: redundancy, de-escalation and duration.

    Conclusion: Overall, physicians were receptive to the ASP program and intervention acceptance increased with each phase of implementation. During phases 1 and 2, the most frequently made interventions were redundancy and de-escalation. During phase 3 the interventions changed to de-escalation, IV-PO, duration and dose change. More interventions were accepted in phase 3 than in the two previous phases. Future program intervention goals are defined duration of antibiotics by post-op category, automatic downgrade substitutions where applicable for certain antibiotics, and development of guidelines based on specific hospital needs and inappropriate antimicrobial usage. A protocol that allows the ASP program to initiate changes is a long term goal.

    Angela Vassallo, MPH, MS1, Snezana Naumovsky, PharmD2, Tanya Elgourt, PharmD2, Robert Winters, MD3, Ellie Goldstein, MD, FIDSA, FSHEA3,4,5 and John Lee, PharmD2, (1)Infection Prevention and Control, Providence Saint John's Health Center, Santa Monica, CA, (2)Pharmacy, Providence Saint John's Health Center, Santa Monica, CA, (3)Providence Saint John's Health Center, Santa Monica, CA, (4)RM Alden Research Laboratory, Santa Monica, CA, (5)Medicine, UCLA School of Medicine, Los Angeles, CA

    Disclosures:

    A. Vassallo, None

    S. Naumovsky, None

    T. Elgourt, None

    R. Winters, None

    E. Goldstein, Merck: Investigator, Research grant

    J. Lee, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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