1002. Evaluation of a Microbiologist-initiated Service to Improve Antibiotic Prescribing for Bacteremia
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Background: Initiation of empiric broad-spectrum antimicrobials, such as piperacillin/tazobactam (TZP) and carbapenems, in severe infections reduces mortality and morbidity. However, prompt culture-directed therapy improves patient outcome and reduce emergence of bacterial resistance. This study reviewed a microbiologist-initiated blood culture service to improve antibiotic prescribing for bacteremia as part of antimicrobial stewardship activities.

Methods: A retrospective study was conducted between January 2014 to March 2015. Bacteremic patients receiving TZP or carbapenems were reviewed. When blood culture results were available, clinical microbiologists provided recommendations to optimise antimicrobial therapy. Follow-up of acceptance was done by the stewardship team and further recommendations made if needed. The primary objective was to compare clinical response between patient groups which accepted or rejected these recommendations. Clinical response at day 7 was defined as being afebrile for at least 24 hours, with cardiovascular and respiratory stability and improving leukocytosis. Secondary outcomes included 30-day mortality, microbiological clearance and 30-day re-admission rate.

Results: A total of 251 recommendations were made, of which 186 (74%) were accepted. The majority of recommendations were related to de-escalation of broad-spectrum antimicrobials (66%). Baseline demographics were comparable between groups. There was no significant difference in clinical response rate [recommendations accepted vs rejected: 51/186 (27%) vs 19/65 (29%), p=0.872]. However, the group with accepted recommendations showed significantly lower 30-day mortality [22/186 (12%) vs 17/65 (26%), p=0.009]. Other outcomes including microbiological clearance [recommendations accepted vs rejected: 48/51 (94%) vs 19/20 (95%)] and 30-day readmission rate [39/164 (24%) vs 11/47 (23%)] were similar between groups.

Conclusion: Acceptance of recommendations by microbiologists coupled with stewardship follow-up to optimize antimicrobial therapy did not worsen clinical response or microbiological clearance, and was possibly associated with improved mortality.

Yee Ding Ng, MPharm with Hons.1, Pu En Ow Yong, MPharm with Hons.1, Teck Kim Tie, MID1,2, Jonathan Seah, PharmD1, Michelle See, PharmD1, Raymond Kok Choon Fong, MBBS, MRCP, DTMH3, Humaira Shafi, MBBS, ABIM3, Thean Yen Tan, MBBCh, MRCPath2 and Qiu Min Yeo, PharmD1, (1)Pharmacy, Changi General Hospital, Singapore, Singapore, (2)Changi General Hospital, Singapore, Singapore, (3)Medicine, Infectious Disease, Changi General Hospital, Singapore, Singapore


Y. D. Ng, None

P. E. Ow Yong, None

T. K. Tie, None

J. Seah, None

M. See, None

R. K. C. Fong, None

H. Shafi, None

T. Y. Tan, None

Q. M. Yeo, None

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