149. Characterization of Redundant Spectrum Antibiotic Use in Community Hospitals: A Stewardship Opportunity
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Background: Redundant antimicrobial combinations result in  antibiotic overuse and are prime target for stewardship interventions.  More data are need on  the frequency of these events in community hospitals 

Methods: Hospitals participating in the Duke Antimicrobial Stewardship Outreach Network (DASON) provided electronic medication administration records from inpatient units for calendar year 2014. These data were queried to find instances in which >1 agent from one of five redundant spectrum categories were administered.  These 5 categories included beta-lactam, antifungal, anti-pseudomonal, anti-anaerobic, and gram-positive agents.  We defined a redundant spectrum event as occurring when two or more agents with a redundant spectrum of activity were administered on more than one calendar day to allow for changes in therapy as part of clinical care. 

Results:

Fourteen community hospitals in the southeastern United States provided data over 753,363 patient days. There were a total of 8,956 redundant spectrum events in 7,013 patients accounting for 33,607 days of redundant therapy.  Incidence of redundant spectrum events was 11.8 per 1,000 patient days.  Redundant  therapy occurred in 6.4% of all admissions in which a patient received an antimicrobial.   The median duration of redundant therapy was 3 days (25th percentile: 2 days; 75th percentile: 4 days) and was greatest for antifungal and anti-anaerobic combinations.  1,937 (21.6%) events occurred in critical care units ; the remainder occurred on general wards.

Table: Redundant spectrum antimicrobial therapy by category

Category

Total Redundant Spectrum Events

Total Redundant TherapyDays

Mean Duration of Redundant  Therapy (days)

Total Admissions with Redundant Therapy/Total Admissions for Therapy Category

Anti-pseudomonal

3,956

15,014

3.8

7.9%

Anti-anaerobic

2,542

10,538

4.1

6.0%

Gram-positive

1,346

4,846

3.6

4.3%

Beta-lactam

1,084

3,083

2.8

1.4%

Antifungal

28

126

4.5

0.4%

Conclusion: Redundant therapy was common in our cohort of community hospitals.  We were unable to assess appropriateness of these regimens.  However, redundant spectra therapy represents an easily definable opportunity for stewardship programs to improve patient care.

Elizabeth Dodds Ashley, PharmD, MHS1, Yuliya Lokhnygina, MS, PhD2, Melissa Johnson, PharmD, MHS1,3, Angelina Davis, PharmD, MS1, Richard H. Drew, PharmD, MS, BCPS, FCCP1,3,4, Daniel J. Sexton, MD, FIDSA, FSHEA1,3, Deverick Anderson, MD, MPH, FIDSA, FSHEA1,3 and Rebekah W. Moehring, MD, MPH1,3,5, (1)Duke Antimicrobial Stewardship Outreach Network, Durham, NC, (2)Biostatistics and Bioinformatics, Duke University, Durham, NC, (3)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (4)Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, (5)Durham VA Medical Center, Durham, NC

Disclosures:

E. Dodds Ashley, UpToDate: Consultant , Consulting fee

Y. Lokhnygina, None

M. Johnson, Astellas: Consultant and Research Contractor , Consulting fee and Research grant

A. Davis, None

R. H. Drew, UpToDate: Contributor , Publication royalty
American Society of Microbiology: Speaker's Bureau , Speaker honorarium
CustomID: Scientific Advisor , Licensing agreement or royalty
Independent Healthcare Education: Speaker's Bureau , Speaker honorarium

D. J. Sexton, None

D. Anderson, None

R. W. Moehring, None

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