982. Impact of a novel antimicrobial stewardship program on reducing the incidence of Clostridium difficile infection and the use of high risk antibiotics in three university hospitals
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Background: Overutilization of broad spectrum antibiotics (BSA) increases the risk for Clostridium difficile infection (CDI). Antimicrobial Stewardship Programs (ASP) have been shown to reduce hospital acquired CDI rates and antimicrobial use. The primary objective of this study was to evaluate CDI/1000 patient days (PD) and BSA utilization pre and post implementation of ASP.

Methods:This was an IRB approved interventional, retrospective review in three university hospitals over a period of nine months. Patients were stratified into pre-ASP and post-ASP groups for analysis. Post-ASP patients were included in the study if they were admitted on one of ASP targeted units (ASPTU) and received BSA. The intervention for this study was a pharmacist led prospective audit on patients on BSA at high risk for CDI not being evaluated by infectious diseases service.

Results:There was a total 763 patients reviewed of which 243 patients were enrolled in the intervention group between the three hospitals. The most common infection noted was respiratory tract (44.4%) followed by urinary tract (38.2%). Nine months after the implementation of ASP the overall hospital acquired CDI rates in ASPTU decreased by 30.4% (9.87 vs. 6.87 CDI/1000PD, p=0.03). There was a total decrease of 19.7% in BSA usage in ASPTU (463.3 vs. 372.14 DOT/1000PD, p=0.001); levofloxacin usage decreased in post-ASP group by 29.6% (131.35 vs. 92.45 DOT/1000PD, p=0.0001) followed by piperacillin/tazobactam with a 22% decrease post-ASP (137.35 vs. 107.2 DOT/1000PD, p=0.0001). Overall, 80% of pharmacist driven recommendations were accepted, with the most commonly accepted interventions being discontinuation of therapy (42%) and de-escalation of therapy (26%). One percent of patients with accepted recommendations suffered from CDI compared to 2.2% in recommendation non-accepted group. There was no difference seen in length of therapy between the groups, however there were trends seen towards decreased length of stay in patients with accepted recommendations (5.2 vs. 6.6 days, p=0.41).

Conclusion:The pharmacy driven ASP recommendations led to a decrease in CDI/1000PD and usage of BSA in ASPTU. Biggest impact of ASP on DOT/1000PD was seen on levofloxacin and piperacillin/tazobactam. Patients with pharmacy driven interventions showed trends towards decreased length of stay.

Nikunj Vyas, PharmD1, Albina Ongari, PharmD1, Cindy Hou, DO, FACOI2 and Shereef Ali, PharmD3, (1)Pharmacy, Kennedy Health, Stratford, NJ, (2)Infectious Diseases, Kennedy Health, Stratford, NJ, (3)Pharmacy, Kennedy Health - Cherry Hill Division, Cherry Hill, NJ


N. Vyas, None

A. Ongari, None

C. Hou, None

S. Ali, None

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