1419. Impact of Infectious Diseases Team Consultation upon Antimicrobial Use, Length of Stay and Mortality in an Adult ICU
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall

Background: Infectious diseases (ID) clinicians and multidisciplinary teams may have a beneficial impact on patient outcomes. We conducted this study to determine the impact of dedicated ID team rounding in an adult non-cardiac intensive care unit (ICU) upon antimicrobial costs, length of stay and mortality.

Methods: We instituted dedicated ICU ID team rounds at a large tertiary care hospital ICU (“intervention”). We compared the cost of antimicrobial agents, total hospital and ICU length of stay and in-patient mortality for the six-month period before and after institution of these rounds between those seen vs. those not seen by the ID team. We excluded patients who were admitted for post-operative step-down care, those who were on antibiotics on study start date and those who were still in the ICU on the study end date.

Results: Among 386 patients analyzed, 206 were admitted in the pre- and 180 in the post-intervention period. Among those seen by the ID team, there was an 18% decrease in total antimicrobial cost (P<0.0001), 40% decrease in ICU length of stay (P=0.1), 33% decrease in overall hospital length of stay (P=0.03) and 34% decrease in mortality (0.04) from pre- to post-intervention period. (Table) Among those not seen by ID, there was a 39% decrease in cost among those not seen by ID (P<0.0001), but length of ICU or hospital stay and mortality were not significantly different.

Conclusion: A dedicated ID team rounding in the ICU leads to substantial decreases in antimicrobial costs, hospital length of stay and in-patient mortality.

Table. Study outcomes in the pre- and post-intervention period.

 

 

Pre-intervention

N=206

Post-intervention

N=180

P-value

% Change

Number seen by ID team, N (%)

45 (21.8)

66 (36.7)

0.001

+ 68.3

APACHE II score (SD)

27.2 (8.6)

24.1 (7.7)

0.08

N/A

Total antimicrobial cost, AED

2,391,634

1,963,883

<0.0001

- 17.9

Mean antimicrobial cost per patient (SD)

53,147 (50,972)

29,755 (38,812)

0.007

- 44.0

Mean length of stay in ICU, days (SD)

26.1 (42.9)

15.7 (24.2)

0.1

- 39.8

Mean hospital length of stay, days (SD)

73.2 (71.0)

48.8 (45.5)

0.03

- 33.2

Number died (%)

26 (57.8%)

25 (37.9%)

0.04

- 34.4

ID, infectious diseases; APACHE II, acute physiology and chronic health evaluation score II; ICU, intensive care unit; AED, United Arab Emirates dirhams;

 

Adeel Butt, MD, MS1,2, Nawal Al Kaabi, MD3, Mohammed Saifuddin, MS3, Kalpana Krishnareddy, MD3, Maqsood Khan, PharmD3, Walid Jasim, MD3, Tehmina Khan, MD3, Masalam Sara, MD3, Marthinus Pitout, PhD3 and Stefan Weber, MD, PhD3, (1)Hamad Healthcare Quality Institute, Doha, Qatar, (2)University of Pittsburgh School of Medicine, Pittsburgh, PA, (3)Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

Disclosures:

A. Butt, Gilead: Grant Investigator , Research grant
AbbVie: Grant Investigator , Research grant

N. Al Kaabi, None

M. Saifuddin, None

K. Krishnareddy, None

M. Khan, None

W. Jasim, None

T. Khan, None

M. Sara, None

M. Pitout, None

S. Weber, None

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