Methods: This retrospective, quasi-experimental study evaluated CAP and HCAP patients admitted to a 350-bed community teaching hospital ICU between January 2011 and June 2012 (pre-ASP) as well as January 2014 and June 2015 (post-ASP). A pharmacist-led ASP was implemented in October 2013 with daily audit and feedback as well as guideline implementation. Study endpoints compared between the pre- and post-ASP groups included the proportion of patients who received appropriate antibiotic treatment based on institutional and national guidelines, time to de-escalation, duration of antibiotic therapy, and total length of ICU and hospital stay. Patient outcomes evaluated included 90-day readmission, in-hospital mortality, reintubation, and Clostridium difficile infection within 30 days.
Results: Compared to the pre-ASP group (n=100), the post-ASP group (n=84) received appropriate empiric antibiotic therapy more frequently (60% vs 86.9%, p<0.001; HCAP 53% vs 98%, p<0.001; CAP 67.3% vs 70.6%, p=0.754). The pre-ASP HCAP group received significantly more double coverage for Pseudomonas (45.1% vs 0%, p<0.001). Median time to de-escalation of antibiotics was shorter (71 hr vs. 60 hr, p=0.029) and de-escalation occurred more often (69% vs 86.9%, p=0.004) in the post-ASP group. There were no significant differences in 90-day readmission (p=0.091), in-hospital mortality (p=0.587), or ICU (p=0.118) and hospital length of stay (p=0.694).
M. Jonkman, None
G. R. Deyoung, None
M. Rauch, None
L. Dumkow, None
See more of: Poster Abstract Session