Methods: An ASP was established at a community teaching hospital in July, 2013, with 32 acuity-adaptable ICU beds. The program was led by an infectious diseases-trained pharmacist who worked daily with a clinical pharmacist rounding with the ICU care team to make ASP interventions. Prospective audit with intervention and feedback began in October, 2013. We chose to compare 12 months of pre-ASP data with 12 months of post-ASP data. Data collected included antimicrobial use and susceptibility trends. Groups were compared based on utilization of antimicrobials which was calculated using Defined Daily Doses (DDD) per 1000 patient days. Antimicrobial susceptibility was compared from 2012 - 2014. ASP interventions were characterized by type and rate of acceptance for all patients admitted to the ICU between October 1, 2013 and September 30, 2014.
Results: In the first year of ASP implementation 1349 ICU interventions were made with an acceptance rate of 96.2%. The majority of interventions were de-escalating or discontinuing antimicrobial therapy (49.8%), dose optimization (15.5%), and intravenous to oral conversion (12.7%). Carbapenem utilization decreased by 77% (meropenem DDD mean: 90.9 vs 24.5, p < 0.001; ertapenem DDD mean: 35.4 vs 4.3, p < 0.001) while fluoroquinolone utilization decreased by 60% (levofloxacin DDD mean: 207.5 vs 72.3, p < 0.001; ciprofloxacin DDD mean: 68.6 vs 32.5, p < 0.002). Pseudomonas aeruginosa susceptibility to ciprofloxacin in the ICU increased by 33% (57% 2012, 68% 2013, 90% 2014) and to meropenem by 21% (69% 2012, 86% 2013, 90% 2014). Escherichia coli susceptibility to ciprofloxacin increased by 15% (68% 2012, 77% 2013, 83% 2014).
Conclusion: A pharmacist-led ASP in a community teaching hospital ICU significantly impacted antimicrobial prescribing, reduced antimicrobial utilization, and saw improved antimicrobial susceptibility trends among Gram-negative organisms.
M. Jonkman, None
M. Galang, None
N. Egwuatu, None