1433. Impact of a Persuasive Antimicrobial Stewardship Campaign to Reduce Moxifloxacin Use and Promote Doxycycline-Containing Regimens for the Treatment of Non-Intensive Care Unit Community-Acquired Pneumonia (non-ICU CAP)
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background:

Antimicrobial stewardship programs (ASP) restricting fluoroquinolone (FQ) prescriptions have been shown to reduce hospital-onset Clostridium difficile infection (HO-CDI) rates.  The impact of ASP promotion of doxycycline, proposed to have a protective effect, on HO-CDI rates is unknown.  We conducted a promotional campaign containing both these initiatives within a non-ICU CAP guideline and measured the impact on antibiotic use and the HO-CDI rate.

Methods:

We performed a single-center, prospective study comparing antibiotic use for adult inpatients before (October 2012 through December 2013) and after (January 2014 through March 2015) an ASP campaign consisting of non-ICU CAP guideline development, provider education, and prospective audit and feedback.  Recommended empiric first-line therapy included ceftriaxone plus doxycycline, with moxifloxacin reserved only for those with a severe beta-lactam allergy or a recent history of beta-lactam or doxycycline treatment failure.  No antibiotics were restricted and no changes in electronic order sets were made.  Primary outcomes included antibiotic days of therapy (DOT)/1,000 patient days (PD) of moxifloxacin, doxycycline, ceftriaxone, and azithromycin, with fluconazole used as a non-equivalent dependent variable.  The incidence of HO-CDI as defined by National Healthcare Safety Network was a secondary outcome.  Mann Whitney U tests were applied where appropriate and the significance level was set to p<0.05.

Results:

Moxifloxacin and azithromycin DOT significantly decreased from 26.0/1,000PD to 10.9/1,000PD (p=0.007), and 43.1/1,000PD to 26.6/1,000PD (p=0.007), respectively.  Doxycycline DOT significantly increased from 8.0/1,000PD to 25.6/1,000PD (p=0.007).  No significant change in ceftriaxone or fluconazole DOT occurred between the two time periods.  The incidence of HO-CDI declined from 8.6 cases/10,000PD pre-intervention to 6.8 cases/10,000PD post-intervention (p=0.095).

Conclusion:

A non-restrictive ASP campaign effectively persuaded providers to use lower-risk antibiotics for CAP and succeeded in significantly reducing moxifloxacin use while significantly increasing doxycycline prescriptions.  This may have contributed to a reduction in HO-CDI rates.

Maryrose Laguio-Vila, MD1,2, Mary Staicu, Pharm.D.3, Ghinwa Dumyati, MD, FSHEA4 and Mary Lourdes Brundige, PharmD3, (1)Infectious Diseases, University of Rochester Medical Center, Rochester, NY, (2)Infectious Diseases, Rochester Regional Health, Rochester, NY, (3)Pharmacy, Rochester Regional Health, Rochester, NY, (4)University of Rochester Medical Center, Rochester, NY

Disclosures:

M. Laguio-Vila, None

M. Staicu, None

G. Dumyati, None

M. L. Brundige, None

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