1450. Impact of infectious disease consultation and prospective carbapenem audit as an antimicrobial stewardship for carbapenem use at a Japanese tertiary care center: An interrupted time series analysis
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDSA presentation 2015 final.pdf (168.5 kB)
  • Background: Although judicious use of broad spectrum antimicrobials should be encouraged to prevent the emergence of multi-drug resistant bacteria, the consumption of such antimicrobials has been increasing worldwide. Given the concern generated by the overuse of broad spectrum antimicrobials, especially carbapenem antimicrobials, we instituted an infectious disease consultation service and prospective carbapenem audit and feedback at a Japanese tertiary care center. 

    Methods: A before-after study was conducted from April, 2012 through March, 2015 at Tokyo Metropolitan Tama General Medical Center, a 790-bed, tertiary care medical center in Tokyo, Japan. Infectious disease consultation (intervention1) was initiated in July, 2013 and an once-weekly prospective audits and feedback on carbapenem antimicrobial use (intervention2) were conducted from April, 2014. Carbapenem use in patients with febrile neutropenia or those with infections susceptible only to carbapenem antimicrobials was considered to be appropriate. Cases considered to be inappropriate for carbapenem use were investigated by a pharmacist, and feedback including recommendations for its discontinuation or replacement with other agents was given to primary care providers. An interrupted time series analysis was performed to assess the impact of the infectious disease consultation and prospective audit on carbapenem use. 

    Results: After implementation of the infectious disease consultation and carbapenem audit, monthly carbapenem use decreased from 17.4 days of therapy (DOT) per 1,000 patient-days in the pre-intervention period to 8.36 DOT per 1,000 patient-days in the subsequent post-intervention periods (proportional reduction 0.48; 95% confidence interval 0.46 to 0.50) with no change in in-hospital mortality. The time series modeling revealed an immediate decrease in carbapenem use due to infectious disease consultation (P=0.01 for intercept), but not due to carbapenem audit and feedback (P=0.98 for intercept and P=0.15 for trend).

    Conclusion: A multifaceted intervention including infectious disease consultation and carbapenem audit appear to be safe and effective in reducing overall carbapenem use.

    Mikihiro Horiuchi, BSc in Pharmacy1, Yasuharu Tokuda, MD, MPH2, Yasuaki Tagashira, MD3, Masanori Higuchi, MD3 and Hitoshi Honda, MD, PhD3, (1)Department of Pharmacy, Tokyo metropolitan Tama general medical center, Tokyo, Japan, (2)Japan Community Healthcare Organization, Tokyo, Japan, (3)Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan

    Disclosures:

    M. Horiuchi, None

    Y. Tokuda, None

    Y. Tagashira, None

    M. Higuchi, None

    H. Honda, None

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