1449. Evaluation of Vancomycin Usage after Implementation of an Antibiotic Stewardship Program: Experience from a Community based Teaching Hospital
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background: We established an Antimicrobial Stewardship Program (ASP) at our hospital with goals to improve clinical outcomes and antimicrobial utilization and monitoring. Our ASP involved prospective chart feedback from our team comprised of a clinical pharmacist and Infectious Diseases (ID) physician.  We performed a retrospective chart review of vancomycin usage within the 12 months prior to and the 12 months after the institution of the ASP. 

Methods: Two studies were approved by the Institutional Review Board (IRB): retrospective analysis of 113 random records of patients who received intravenous vancomycin for at least 48 hours within the 12 months before the implementation of ASP and a retrospective review was performed on 100 random records of patients receiving vancomycin for at least 48 hours in the 12 months after ASP.  Each study was designed to analyze the vancomycin usage as either empiric or definitive by collecting data including weight, renal function, drug dose, drug levels, and culture data. 

Results:  There were no significant differences between the groups’ baseline characteristics. The ASP led to an increase in patients that received initial doses consistent with the hospital’s vancomycin protocol (28% vs. 16.8%, p=0.001); a decrease in the median duration of vancomycin treatment (5 vs. 2.8 days, p=0.0001); a decrease in Infectious Diseases (ID) consults obtained (46% before vs. 19% after, p=0.0005). Pharmacokinetic analysis showed that the ASP resulted less inappropriate dose changes (12.9% vs. 40%, p=0.0005) and increased the trough levels at goal (54.8% vs. 40%, p=0.001). 

Conclusion: The comparative analysis of vancomycin usage shows that the implementation of a multidisciplinary, physician-supervised ASP in our community teaching hospital increased the appropriateness of vancomycin use by decreasing the duration of empiric therapy and increasing patients placed on the correct initial dosing.  We found an unexpected decrease in ID consults in the period after establishment of our ASP.  We hypothesize ID clinician involvement, better awareness of our vancomycin dosing protocol, prescriber education and pharmacist interventions all contributed. Our findings for vancomycin offers plausibility that our ASP also impacts utilization of other antimicrobials.

Theodora Anagnostou, MD1,2, Poorani Goundan, MBBS3,4, Eric Hoynack, .5, Margo Delisls, .5, Paul Le, .5, Oussayma Moukhachen, PharmD, BCPS5,6 and Barbra M. Blair, MD4,6, (1)Medicine, Mount Auburn Hospital, Cambridge, MA, (2)Medicine, Harvard Medical School, Boston, MA, (3)330 Mount Auburn Street, Mount Auburn Hospital, Cambridge, MA, (4)Harvard Medical School, Boston, MA, (5)Massachusetts College of Pharmacy and Health Sciences, Boston, MA, (6)Mount Auburn Hospital, Cambridge, MA

Disclosures:

T. Anagnostou, None

P. Goundan, None

E. Hoynack, None

M. Delisls, None

P. Le, None

O. Moukhachen, None

B. M. Blair, None

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