1415. Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program (ASP) at a Veterans Affairs Medical Center: A Six-Point Assessment
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
  • IDweek_2015_ASP_FINAL.pdf (367.7 kB)
  • Background: Prospective audit and feedback (PAF) is a core ASP strategy; however the impact of these programs has been difficult to measure. 

    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.

    Haley Morrill, PharmD1,2,3, Aisling Caffrey, PhD, MS1,2,4, Melissa Gaitanis, MD5,6 and Kerry Laplante, PharmD1,2,4,5, (1)College of Pharmacy, University of Rhode Island, Kingston, RI, (2)Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, (3)Providence Veterans Affairs Medical Center, Providence, RI, (4)Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, (5)Warren Alpert Medical School of Brown University, Providence, RI, (6)Infectious Diseases, Providence Veterans Affairs Medical Center, Providence, RI


    H. Morrill, None

    A. Caffrey, Pfizer: Research Support , Grant recipient

    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

    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.