1888. Antimicrobial Stewardship in Long Term Care Facilities: Lessons Learned
Session: Poster Abstract Session: Antibiotic Stewardship: Long Term Care
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • ID Week Poster October 2016--FINAL.pdf (745.2 kB)
  • Background: Studies suggest 25-75% of antibiotics (abx) are inappropriate in long term care facilities (LTCF). Antimicrobial Stewardship Programs (ASP) are limited in LTCF but can be successful. One study demonstrated a decrease in abx usage by 30% post intervention (intv) and significant decrease in Clostridium difficile (C. diiff) colitis cases. Outcome measures are difficult to track as there are no centralized monitoring systems.

    Methods: This is a retrospective cohort analysis, comparing pre/post intv May-Nov 2014/2015 data in 5 LTCF where Kaiser Permanente geriatricians round. We reviewed charts and discussed pts with geriatricians once/week. ID consultation was available 24/7.

    Primary endpoints: 1. Decrease in antimicrobial days of therapy (DOT), measured by abx days avoided and associated cost savings. 2. De-escalation of antimicrobial therapy, measured by # days of broad-spectrum abx avoided. Abx were ranked 1-4, 1=most narrow-spectrum, 4=broadest spectrum.  Secondary endpoint: evaluate C. diff infections and rehospitalization rate at 30 days post-ASP intv.

    Results:

    Total # pts in study: 188

    # cases: instances any pt was discussed: 231

    # interventions: each abx discussed (some cases had >1 intv): 294

    # diagnoses: diagnosis of each intv (some pts had >1 dx): 245

     

    Male

    Female

    # pts:

    80 (42.55%)

    108 (57.45%)

    Ages

    20-95

    31-95

    Mean age

    74.2

    76.6

     

    Dx

    # dx

    %

    UTI

    78

    32%

    Resp inf

    71

    29%

    Skin/soft tissue

    35

    14%

    C diff

    19

    8%

    Bone/joint

    17

    7%

    Bacteremia

    13

    5%

    GI

    8

    3%

    Other

    4

    2%

    Intv changes were made in 167/231 (72%) cases.

    Fig 1: Types of interventions.

    Abx changes occurred among 50/294 (17%) intvs.

    Fig 2: Rankings before/after interventions.

    Total DOT and cost savings:

    Days of Therapy (DOT)

    Total Amount

    Cost

    DOT Saved

    1028

    $28,458

    DOT Extended

    609

    $13,754

    Net

    419

    $14,704

    Fig 3: Top sampling of abx saved.

    Among 231 cases, 7 developed C. diff within 30 days post-intv; of these, 3 had a hx C diff. Comparing 2014 and 2015 June-Nov  C diff rates (# cases/1000 pt days):

    2014

    2015

    P value

    28.05

    18.61

    (χ2=3.49, p<.06)

    Of 231 cases, 57/231 (24.7%) were readmitted to the hospital within 30 days of intv.

    Conclusion: ASP in LTCF decreased DOT and cost. While C. diff rates were not significantly decreased, we identified future data collection priorities for LTCFs including hospital readmission and prior abx usage.

    Jana Dickter, MD1, Bin Xiao, PharmD2, Umber Chohan, MD3, Frances Wong, PharmD4, Quinn Ho, MS5 and Betty Tseng, PharmD2, (1)Infectious Diseases, City of Hope, Duarte, CA, (2)Kaiser Permanente, Ontario, CA, (3)Infectious Diseases, Kaiser Permanente, Woodland Hills, CA, (4)Kaiser Permanente, Fontana, CA, (5)Hospital Administration, Kaiser Permanente, Fontana, CA

    Disclosures:

    J. Dickter, None

    B. Xiao, None

    U. Chohan, None

    F. Wong, None

    Q. Ho, None

    B. Tseng, None

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