1413. Characterizing Antimicrobial Stewardship Interventions and Acceptance Rates at a Tertiary Care Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Cole_IDWEEK_Stewardship_Interventions_2015.pdf (431.7 kB)
  • Background: In December 2014, a new pharmacy procedure was implemented for documentation of antimicrobial stewardship (AS) interventions at our institution. This review was conducted to compare interventions between general clinical pharmacists and an infectious disease (ID)-trained pharmacist to target future educational efforts.

    Methods: Cohort study included all AS interventions from January 1, 2015-April 30, 2015. Entries excluded if they contained no information, had an un-finalized follow-up status, were a communication entry, or reinforced ID consultation recommendations.

    Results: 636 entries screened; 448 included. Overall, 71.9% performed by ID-trained pharmacist, 13.1% by other pharmacists, 15% by pharmacy residents.  Most common category of stewardship intervention was related to antimicrobial selection (54.9%) and most commonly regarding broad-spectrum β-lactams (42.0%). Comparison of antimicrobial selection and dosing interventions are shown in Tables 1 and 2, respectively. The ID-trained pharmacist was more likely to make non-drug related interventions compared to other pharmacists (9.6% vs. 2.4%, p = 0.009) and overall, the recommendations made by the ID-trained pharmacist were more likely to be rejected (7.8% vs. 17.5%, p = 0.016), although rejection rate was low in both groups.

    Conclusion: Interventions made by the ID-trained pharmacist were often more complex in nature, particularly involving pharmacokinetic/pharmacodynamic (PK/PD) dose adjustments and non-drug related recommendations. These are areas to target education and perhaps could explain the discrepancy in acceptance rates between ID-trained and non-ID-trained pharmacists.  

    Table 1. Antimicrobial Selection Interventions by Pharmacist Type

    Intervention Type

    ID-Trained Pharmacist

    (n =  155)

    Non-ID-Trained Pharmacist

    (n = 91)

    P-Value

    Empiric Therapy

    10 (6.5%)

    17 (18.7%)

    0.003

    Definitive Therapy

    86 (55.5%)

    29 (31.9%)

    <0.001

    Starting/Stopping Therapy

    57 (36.8%)

    45 (49.5%)

    0.051

    IV to PO Conversion

    2 (1.3%)

    0

    0.532

    Table 2. Antimicrobial Dosing Interventions by Pharmacist Type

    Intervention Type

    ID-Trained Pharmacist

    (n = 12 )

    Non-ID-Trained Pharmacist

    (n = 32)

    P-Value

    Renal Adjustment

    1 (8.3%)

    15 (46.9%)

    0.032

    PK/PD Adjustment

    11 (91.7%)

    17 (53.1%)

    0.032

    Kelli Cole, PharmD, BCPS, John Macko, PharmD and Claudiu Georgescu, MD, University of Toledo Medical Center, Toledo, OH

    Disclosures:

    K. Cole, None

    J. Macko, None

    C. Georgescu, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.