741. A Syndromic Evidence-Based Antibiotic Prescribing Tool To Improve Empiric Therapy for 1-90 Day Febrile Infants
Session: Oral Abstract Session: The NICU and Beyond
Friday, October 9, 2015: 11:18 AM
Room: 32--ABC

Background: Traditional antibiograms aid antibiotic selection by displaying the proportion of select bacterial pathogens that are susceptible to specific antibiotics based on local microbiology. Antibiograms do not provide guidance regarding the effectiveness of empiric antibiotics for specific syndromes based on probable bacterial pathogens for which treatment is being considered. Intermountain Healthcare (IH) implemented a febrile infant evidence based care process model (EB-CPM) in 2008 that recommends different antibiotic regimens based on age and syndrome.

Objective: Demonstrate utility of a syndromic evidence-based antibiotic prescribing tool in 1-90 day old febrile infant serious bacterial infection (SBI) syndromes.

Methods: We identified febrile infants 1-90 day old with SBI at any IH facility between July 2004 and Dec 2014. Infants were assigned to a syndrome based on testing and culture results.  A traditional antibiogram was constructed for each syndrome pathogen based on historical microbiological data. The prevalence of each pathogen was weighted by multiplying the prevalence by the percent susceptible. The predicted susceptibility was calculated as the sum of the susceptible isolates divided by the total number of syndrome isolates.

Results: 13,621 episodes were identified during the study period. Confirmed SBI occurred in 1427/10659 (13%) episodes with culture(s) performed. Predicted susceptibilities for possible empiric regimens ranged from 79% for cefotaxime alone for bacteremia in 1-28 day infants to 98% for the EB-CPM recommended regimen for confirmed meningitis in 1-90 day infants.

 

Conclusion: An evidence-based syndromic antibiotic prescribing tool that uses local historical microbiological data to compare predicted susceptibility rates for empiric antibiotic regimens may be used to evaluate guideline or antimicrobial stewardship recommendations. The tool can easily be adapted for other clinical syndromes.

 

E. Kent Korgenski, MS1, Chris Stockmann, MSc2, Per Gesteland, MD3, Andrew Pavia, MD, FIDSA, FSHEA, FPIDS2, Emily Thorell, MD, MSCI2, Edward Stenehjem, MD MSc4, Adam L. Hersh, MD, PhD5, Jared Olson, PharmD6 and Carrie L. Byington, MD, FIDSA7, (1)Department of Pediatrics, Pediatric Clinical Program, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT, (2)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (3)University of Utah, Salt Lake City, UT, (4)Medicine, Intermountain Medical Center, Atlanta, GA, (5)University of Utah School of Medicine, Salt Lake City, UT, (6)Primary Children's Hospital, Salt Lake City, UT, (7)Pediatrics, University of Utah, Salt Lake City, UT

Disclosures:

E. K. Korgenski, None

C. Stockmann, None

P. Gesteland, None

A. Pavia, None

E. Thorell, None

E. Stenehjem, None

A. L. Hersh, Pfizer: Grant Investigator , Grant recipient and Research grant

J. Olson, None

C. L. Byington, None

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