Program Schedule

243
Role of a Dedicated Full-time Infectious Diseases Pharmacist in Antimicrobial Stewardship: a Tale of Two Veterans Affairs Medical Centers

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • antimicrobial stewardship poster (final).pdf (184.0 kB)
  • Background:

    Antimicrobial stewardship can minimize adverse events from antibiotics, development of resistance, and costs.  Two potential stewardship targets are in initiation and streamlining of therapy.

    Methods:

    We examined indicators of quality in initiating and streamlining antibiotic therapy between two Veterans Affairs (VA) hospitals with different stewardship programs: VA Greater Los Angeles (GLA), which has a dedicated full-time infectious diseases (ID) pharmacist who reviews all broad-spectrum parenteral antibiotic usage, and the Denver VA (DEN), which has a more decentralized model where individual ward pharmacists are responsible for stewardship. We reviewed a sample of 300 cases of inpatient parenteral antibiotic use (200 at GLA from 10/2011-10/2012 and 100 at DEN from 7/2010-6/2011).

    Results:

    For antibiotic indication, GLA cases were more likely to have an indication for antibiotic therapy documented [199/200 (99%) vs. 95/100 (95%), p=0.017] and appropriate empirical therapy prescribed [194/200 (97%) vs. 87/100 (87%), p=0.002] but were less likely to have appropriate cultures collected [121/186 (65%) vs. 82/100 (82%), p=0.002].  For antibiotic streamlining, GLA cases were more likely to have therapy modified within 24 hours of lab data being available [133/152 (87%) vs. 37/51 (73%), p=0.016], to be converted to oral medication appropriately [100/123 (81%) vs. 41/67 (61%), p=0.003], and to have antibiotics discontinued when bacterial infection was determined to not be present [39/50 (78%) vs. 11/33 (33%), p<0.0001].  The presence of any streamlining activity was higher at GLA regardless of whether ID consultation was obtained [174/191 (91%) vs. 47/95 (49%) overall and 128/143 (90%) vs. 36/70 (51%) without ID consult, p<0.0001 for both].

    Conclusion:

    Our findings strongly support the presence of a full-time ID pharmacist in antimicrobial stewardship, particularly in influencing streamlining of therapy, but opportunities for improvement in both initiation of and streamlining of therapy still exist even when a full-time ID pharmacist is present.

    Andrew Ma, MD1,2, Randolph Fugit, PharmD, BCPS3, Thuong Tran, PharmD2, Mary Bessesen, MD3,4 and Christopher Graber, MD, MPH2, (1)Cedars-Sinai Medical Center, Los Angeles, CA, (2)VA Greater Los Angeles Healthcare System, Los Angeles, CA, (3)Denver Veterans Affairs Medical Center, Denver, CO, (4)University of Colorado Denver, Aurora, CO

    Disclosures:

    A. Ma, None

    R. Fugit, None

    T. Tran, None

    M. Bessesen, None

    C. Graber, None

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