1673. Feasibility Assessment of Stewardship Interventions in Community Hospitals: a Multicenter, 3-Stage Cluster-Randomized Historically Controlled Crossover Trial
Session: Oral Abstract Session: MultiCenter Stewardship Interventions
Friday, October 28, 2016: 2:00 PM
Room: 288-290

Background: Feasibility of “core” antimicrobial stewardship strategies is uncertain in small, community hospitals. 

Methods: We performed a multicenter randomized historically-controlled crossover trial to determine the feasibility of and outcomes from 2 standard antimicrobial stewardship interventions in 4 community hospitals participating in DASON.  The primary aim was to determine the feasibility of implementing 2 core strategies performed by local pharmacists, antimicrobial pre-authorization (PreA) and post-antibiotic review and feedback (PAR).  Strategies targeted 3 antibiotics (vancomycin, piperacillin-tazobactam (P/T), and carbapenems (CP)).  Trained pharmacists performed each for 6 months with a 1-month wash out period between.  Hospitals were randomized to order of interventions.  Pharmacist and physicians were polled using a structured survey after each intervention arm.  Secondary outcomes included intervention results, days of therapy (DOT) in each arm. 

Results: Both strategies were approved for implementation at participating hospitals. A total of 1,199 out of 14,812 eligible patients received a targeted antibiotic during a PreA period and 1,022 out of 14,090 during a PAR period.  Pharmacists recommended antibiotic change more often during PAR than PreA, but recommendations were less likely to be followed (Table, Figure 1). Survey responding physicians perceived both strategies equivalently. The mean DOT of P/T was lower in the PAR arm (0.45 v. 0.56, diff=0.10, 95% CI 0.05-0.15; Figure 2). 

Conclusion: Core antimicrobial stewardship interventions are feasible and well received in small community hospitals. 

 

Table.  Interventions and Perceptions – Implementing core stewardship interventions in community hospitals.

 

PreA

n (%)

PAR

n (%)

p-value

 

N=1205

N=1029

 

Any change recommended

158 (15)

326 (36)

<0.001

Recommendation not followed*

96 (6)

148 (12)

<0.001

Physician perception

N=45

N=41

 

Recommendations improved care

26 (59)

22 (56)

0.8

Recommendations changed prescribing strategy

16 (37)

16 (40)

0.8

Not burdensome

28 (65)

20 (53)

0.3

Chose alternative drug to avoid pharmacist

20 (47)

19 (51)

0.7

*Potentially more than one intervention/targeted antibiotic per patient: n=1609 PreA; n=1273 PAR.

Deverick Anderson, MD, MPH, FIDSA, FSHEA1, Shera Watson, MPH2, Rebekah W. Moehring, MD, MPH1,3,4, Lauren Komarow, MS5, Matthew Finnemeyer, MPH5, Rebekka Arias, BS6, Jacqueline Huvane, PhD6, Carol Hill, PhD6, Nancie Deckard, CCRA, BSN, MS6, Vance G Fowler Jr, MD, MHS7, Daniel J. Sexton, MD, FIDSA, FSHEA1,3 and the Antibacterial Resistance Leadership Group, (1)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, NC, (4)Durham VA Medical Center, Durham, NC, (5)Harvard TH Chan School of Public Health, Boston, MA, (6)Duke Clinical Research Institute, Durham, NC, (7)Infectious Diseases, Duke University Medical Center, Durham, NC

Disclosures:

D. Anderson, None

S. Watson, None

R. W. Moehring, None

L. Komarow, None

M. Finnemeyer, None

R. Arias, None

J. Huvane, None

C. Hill, None

N. Deckard, None

V. G. Fowler Jr, None

D. J. Sexton, None

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