966. Development of Operationalized Intravenous to Oral Antibiotic Switch Therapy Criteria
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • 1Poster%20ID%20Week%202-3.pdf (757.7 kB)
  • Background: Early switch from intravenous (IV) to oral antibiotic therapy plays an important role in antibiotic stewardship programs. Despite huge overlap in suggested criteria for a safe switch, there is considerable variation in the operationalization of these criteria. Here we report the development of operationalized switch criteria, i.e. a set of measurable conditions that should all be met in any adult hospitalized patient for a safe switch of IV therapy.

    Methods: A 4 step international RAND-modified Delphi procedure was performed to develop a set of operationalized IV to oral switch criteria. Switch criteria and their accompanying suggested measurable conditions were extracted from the literature and were appraised by a multidisciplinary expert panel during 2 questionnaire rounds with an in-between face to face meeting. In a final step, the experts could approve the set of developed operationalized switch criteria.

    Results: Seven switch criteria and 41 accompanying measurable conditions extracted from the literature were appraised in the 4 step Delphi procedure. The Delphi procedure ultimately resulted in the selection of 16 measurable conditions that operationalize 6 switch criteria: (1) Stable systolic blood pressure. Absence of: (2) fever, (3) under temperature, (4) malabsorption syndrome, (5) short bowel syndrome, (6) severe gastroparesis, (7) ileus, (8) continuous nasogastric suction, (9) vomiting, (10) (severe) sepsis, (11) fasciitis necroticans, (12) central nervous system infection, (13) Staphylococcus aureus bacteremia and (14) endovascular infection. In addition (15) the patient should be cooperative and (16) adequate antimicrobial concentration should be achievable at the site of infection by oral administration.

    Conclusion: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 intravenous to oral antibiotic switch criteria operationalized by 16 measurable conditions. Future use in audits and as rules in computer assisted decision support systems will facilitate the performance and evaluation of switch projects as important part of antimicrobial stewardship programs.

    Hassna Akhloufi, PhD candidate, Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands, Marlies Hulscher, Professor, Radboud University Medical Center, Nijmegen, Netherlands, Heleen Van Der Sijs, PhD, Erasmus MC University Medical Center, Rotterdam, Netherlands, Jan M. Prins, Professor, MD, Internal Med., Infectious Diseases, Tropical Med. and AIDS, Ctr. for Infection and Immunity Amsterdam (CINIMA), Academic Med. Ctr., Amsterdam, Netherlands, Damian Melles, MD, Department of Medical Microbiology and Infectious Diseases, Rotterdam, Netherlands and Annelies Verbon, Professor, MD, Erasmus Medical Center, Rotterdam, Netherlands

    Disclosures:

    H. Akhloufi, None

    M. Hulscher, None

    H. Van Der Sijs, None

    J. M. Prins, None

    D. Melles, None

    A. Verbon, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.