1035. Successful antimicrobial stewardship interventions in a Dutch general hospital
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Poster IDweek 20160808 pdf.pdf (804.8 kB)
  • Background: Antimicrobial Stewardship was introduced in 2014 in a general hospital (14.000 admissions). The goal was to optimize antimicrobial prescribing in order to improve individual patient care and to decrease the spread of antimicrobial resistance. Interventions and the antibiotic use over 2014 and 2015 were registered

    Methods: Strategies for changing antimicrobial prescribing behaviour included education of prescribers, new antimicrobial guidelines and appropriate use of antimicrobial drugs. 1. The antimicrobial committee created a new antimicrobial formulary with restricted prescribing of antimicrobial agents. 2. The antibiotic team (A-team) was installed, including an infectious diseases specialist, a hospital based pharmacist and a medical microbiologist. 3. The A-team visited all clinical wards twice a week. The A-team aimed to reduce the use of amoxicillin/clavulanic acid and ciprofloxacin in 2015 because of the increasing resistance of microorganisms. Cefazolin was introduced as the new antibiotic prophylaxis in surgery. The prescribing behaviour was measured.

    Results: In 2014 (Q3-4) and 2015 (Q1-4), respectively 413 and 1019 patients were discussed by the A-team and the interventions registered (figure 1). The mean intervention per patient was reduced from 0.51 to 0.41. The dispensing of intravenous amoxicillin/clavulanic acid and ciprofloxacin, and their antibiotic use density (DDD/100 patient days) decreased significantly (figure 2). The use of preoperative cefazolin increased 1016%.

    Figure 1. Distribution of proposed interventions 

    Figure 2. Antibiotic use

    Conclusion: The A-team had direct control over antimicrobial use. A change in antimicrobial prescribing behaviour was seen. The average number of interventions per patient decreased 14,7%. The “stop antibiotic” intervention decreased 63%. Some intervention increased, signaling a delay in decision making until the A-team visited the ward. A reduction of the amount of amoxicillin/clavulanic acid (42-51%) and ciprofloxacin (20-30%) and increase of the use of preoperative cefazolin (1016%) was seen. The resistance data show no significant change with the exception of ciprofloxacin (reduced from 13.7 to 10.9%).

     

    Gerard Van Asselt, MD, PhD, Medical Microbiology, SHL-group, Etten-Leur, Netherlands, Casper Van Der Hoeven, PharmD, Hospital Pharmacy, Van Weel-Bethesda Hospital, Dirksland, Netherlands, Suba Lugtenburg, MD, Infectious Diseases, Van Weel-Bethesda Hospital, Dirksland, Netherlands and Chris Roggeveen, MD, SHL-group, Etten-Leur, Netherlands

    Disclosures:

    G. Van Asselt, None

    C. Van Der Hoeven, None

    S. Lugtenburg, None

    C. Roggeveen, 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.