Methods: This quasi-experimental study measured the impact of a PAF ASP on clinical outcomes, antimicrobial use, resistance, costs, and patient safety indicators such as adverse drug events (ADE) and Clostridium difficileinfection (CDI). Propensity adjustment and matching of Cox proportional hazards regression models was done to quantify the effect of ASP on time to hospital discharge (DC, primary) and 30-day mortality, inpatient mortality, and 30-day readmission (secondary). Antimicrobial use was measured as days of therapy/1000 patient-days (DOT/1000PD) and pre-post differences assessed with t-tests. Interrupted time series (ITS) analyses were performed to assess temporal trends in antimicrobial use, costs, and CDI.
Results: 2,696 patients were included (49.0% pre, 51.0% post) during a pre (9/10–10/11) and post (9/12–10/13) ASP period. Median antimicrobial DOT and time to DC were 1 day less for patients in the post period (DOT: 4 days, IQR 2-8 vs 5 days, IQR 2-9, p <0.01; DC: 4 days, IQR 2-7 vs 5 days, IQR 3-8, p <0.01). In adjusted and matched analyses, there were no differences in time to DC or any of the secondary outcomes assessed. Overall mean monthly antimicrobial use was similar between periods. There was a significant decrease in broad-spectrum (-11.3%), fluoroquinolone (-27.0%), and anti-pseudomonal (-15.6%) use. ITS analyses demonstrated a significant increase in monthly carbapenem use after the intervention (+1.5 DOT/1000PD per month; 95% CI 0.1-3.0). No other significant temporal trends in use were identified. Resistance was similar between periods for most bug-drug combinations assessed. No significant changes in monthly trend for costs or CDI were observed. Non-significantly fewer patients experienced an ADE in the post vs. pre-ASP period (4.4% vs 6.0%; p=0.06).
Conclusion: Our ASP was associated with improvements in broad-spectrum, fluoroquinolone, and anti-pseudomonal use. Clinical outcomes were similar between periods, however in unadjusted analyses time to DC was shorter post ASP. Resistance, costs and patient safety indicators did not significantly change between pre- and post-ASP periods. PAF ASPs may have the capacity to improve antimicrobial use and clinical outcomes, and contain bacterial resistance trends.
M. Gaitanis, None
K. Laplante, Cubist Pharmaceuticals: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Pfizer Pharmaceuticals: Grant Investigator , Grant recipient
Theravance Biopharma: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient
Durata: Scientific Advisor , Consulting fee
Forest Laboratories: Scientific Advisor , Consulting fee
Marvao: Grant Investigator , Grant recipient
Melinta: Scientific Advisor , Consulting fee
Davol: Scientific Advisor , Consulting fee
Theradoc: Scientific Advisor , Consulting fee